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Implementation of Less Invasive Surfactant Administration (LISA) for Preterm Neonates with Respiratory Distress Syndrome: A Quality Improvement Initiative: Authors' Reply.

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Implementation of Less Invasive Surfactant Administration (LISA) for Preterm Neonates with Respiratory Distress

Triptee Agrawal1, Mandula Phani Priya1, Venkataseshan Sundaram2

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Indian Journal of Pediatrics
|July 15, 2025
PubMed
Summary

A quality improvement initiative successfully increased less invasive surfactant administration (LISA) rates from 0% to 90% in neonates over 10 months, exceeding the 50% target.

Keywords:
CPAPInSurELISASurfactant

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Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Quality Improvement in Healthcare

Background:

  • Less invasive surfactant administration (LISA) is a method for delivering surfactant to premature infants.
  • Implementing new clinical procedures requires structured approaches for successful adoption.

Purpose of the Study:

  • To initiate and increase the rate of less invasive surfactant administration (LISA) by 50% within 10 months using a quality improvement (QI) approach.
  • To evaluate the effectiveness of a QI methodology in enhancing LISA adoption in a clinical setting.

Main Methods:

  • A quality improvement (QI) methodology was employed, focusing on the proportion of surfactant administered via LISA as the primary outcome.
  • Root cause analysis through focus group discussions, comprehensive training on LISA technique and complication management, and multiple Plan-Do-Study-Act (PDSA) cycles were implemented.
  • A standard operating policy for LISA was developed and applied to all neonates requiring surfactant.

Main Results:

  • The proportion of neonates receiving surfactant via LISA increased significantly from 0% to 90% over the 10-month study period.
  • Initial complication rates, including desaturation (74%), surfactant reflux (32.1%), bradycardia (25%), and unilateral administration (26.7%), were substantially reduced.
  • Post-intervention complication rates decreased to 7.4% for desaturation, 3.7% for surfactant reflux, and 7.4% for bradycardia and unilateral administration.

Conclusions:

  • The utilization of QI tools effectively facilitated a rapid and substantial increase in the rate of surfactant administration via the LISA method, surpassing the initial 50% target.
  • The QI approach proved successful in both increasing the adoption of LISA and mitigating associated complications in neonatal care.