Less invasive surfactant administration (LISA): chances and limitations

Area of Science:

• Neonatology
• Pediatric Pulmonology
• Critical Care Medicine

Background:

• Continuous positive airway pressure (CPAP) is standard for premature infant respiratory distress.
• CPAP failure can occur due to surfactant deficiency, a hallmark of respiratory distress syndrome.
• Less invasive surfactant administration (LISA) offers an alternative to positive pressure ventilation.

Purpose of the Study:

• To review the efficacy of LISA compared to standard treatments and the INtubate-SURfactant-Extubate (INSURE) procedure.
• To highlight the benefits of spontaneous breathing during surfactant delivery.
• To identify areas for future research in LISA techniques and patient management.

Main Methods:

• Review of individual studies and meta-analyses on LISA.
• Comparison of LISA with CPAP and INSURE procedures.
• Analysis of short-term and long-term infant outcomes.

Main Results:

• LISA is more effective than standard treatment and INSURE in avoiding mechanical ventilation.
• LISA is associated with better long-term outcomes, including reduced risk of intracerebral hemorrhage and bronchopulmonary dysplasia.
• The procedure allows infants to maintain spontaneous breathing, leveraging the glottis function.

Conclusions:

• LISA represents a significant advancement in respiratory support for preterm infants.
• Further research is needed on optimal treatment thresholds, specialized devices, and analgesia/sedation protocols.
• LISA is a key component of a comprehensive non-invasive strategy for gentle extrauterine transition.