Original ArticleOutcomes after Introduction of Minimally Invasive Surfactant Therapy in Two Australian Tertiary Neonatal Units
Section snippets
Methods
MIST was introduced into standard care at 2 Melbourne NICUs: Monash Children's Hospital (MCH) in March 2018, and at The Royal Women's Hospital (RWH) in August 2018. Although a small group of clinicians at each center had limited experience in MIST from participating in a clinical trial, the majority were inexperienced in this technique before its introduction into routine practice.8 Infants eligible for MIST were from 23 to 40 weeks' gestational age at MCH, and from 29 to 36 weeks' gestational
Results
During the audit period, 122 infants were treated with MIST, of whom 75 were at MCH and 47 at RWH. The demographics of included infants are shown in Table I. Almost all infants were preterm (120/122 [98.4%]), with the majority (86/122 [70.5%]) being born at <32 weeks of gestation, and 31 of 122 (25.4%) at <28 weeks of gestation. The most preterm infant was born at 236/7 weeks of gestation. There were 29 infants born at nontertiary centers and transferred to MCH or RWH before receiving MIST.
Discussion
This audit demonstrates successful adoption of MIST into standard practice at 2 tertiary NICUs in Australia. This treatment was applied in a population ranging in gestational age from 236/7 weeks to term, but primarily composed of very preterm infants born at <32 weeks of gestation, the group at highest risk of RDS. Surfactant administration was successfully completed in all but 1 procedure, in which the infant required intubation for apnea.
Exogenous surfactant administration, whether by
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Randomized Trial of Surfactant Therapy via Laryngeal Mask Airway Versus Brief Tracheal Intubation in Neonates Born Preterm
2023, Journal of PediatricsCitation Excerpt :Approaches to surfactant delivery via thin catheter have not been compared with LMA as a conduit. Because experienced clinicians are more successful at performing laryngoscopy and tracheal catheterization using the thin catheter approach,34 some NICUs have standardized the procedure to be undertaken only by senior clinicians.35 LISA may be technically difficult to perform without sedation, resulting in a first attempt failure rate as high as 48%.36
Noninvasive respiratory support
2022, Goldsmith's Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care, Seventh EditionCapnography for catheter location confirmation in minimally invasive surfactant administration
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C.R. is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant (1175634) and has received conference travel support from Fisher and Paykel. B.M. is supported by a Medical Research Future Fund (Australia) Next Generation Clinical Researchers Career Development Fellowship (MRF1159225). The other authors declare no conflicts of interest.