Elsevier

The Journal of Pediatrics

Volume 229, February 2021, Pages 141-146
The Journal of Pediatrics

Original Article
Outcomes after Introduction of Minimally Invasive Surfactant Therapy in Two Australian Tertiary Neonatal Units

https://doi.org/10.1016/j.jpeds.2020.10.025Get rights and content

Objective

To assess the procedural and clinical outcomes associated with the introduction of minimally invasive surfactant therapy (MIST) into standard care at 2 tertiary Australian neonatal intensive care units.

Study design

A prospective audit was designed before the introduction of MIST in 2018, with data collected over a period of 18 months. Procedural data were completed by the clinical team performing MIST, including clinical observations, medication use, and adverse events. The audit team collected demographic data and subsequent clinical outcomes from medical records.

Results

There were 135 MIST procedures recorded in 122 infants. For the included infants, the median gestation was 302/7 weeks (IQR, 276/7 to 322/7 weeks) and birth weight was 1439 g (IQR, 982-1958 g). During the MIST procedure, desaturation to a peripheral oxygen saturation of <80% was common, occurring in 75.2% of procedures. Other adverse events included need for positive pressure ventilation (10.6%) and bradycardia <100 beats per minute (13.3%). The use of atropine premedication was associated with a significantly lower incidence of bradycardia: 8.6% vs 52.9% (P < .01). Senior clinicians demonstrated higher rates of procedural success. The majority of infants (63.9%) treated with MIST did not require subsequent intubation and mechanical ventilation.

Conclusions

MIST can be successfully introduced in neonatal units with limited experience of this technique. The use of atropine premedication decreases the incidence of bradycardia during the procedure. Success rates can be optimized by limiting MIST to clinicians with greater competence in endotracheal intubation.

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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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.

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