546 - Surfactant Administration via Laryngeal Mask Airway as First-Line Therapy for Selected Newborns (32–38 Weeks GA) in a Community Neonatal Unit

Publication Number: 3527.546

ivana culic, Beth Israel Deaconess Medical Center, Boston, MA, United States; Jennifer W. Lee, Harvard Medical School, Beth Israel Deaconess Medical Center, Newbury, MA, United States

Background: Surfactant delivery via laryngeal mask airway (LMA) has shown strong outcomes nationally but additional local implementation outcomes in community practice settings are needed. Beverly Hospital manages 2,200 deliveries and 340 NICU admissions annually, caring for infants ≥32 weeks gestation. The unit provides CPAP but not mechanical ventilation. Traditionally, infants with respiratory distress syndrome (RDS) received surfactant via endotracheal tube (ETT) after premedication and intubation, followed by extubation if possible, or transfer to a higher-level NICU. This approach resulted in sedation exposure, family separation, and increased cost.

Objective: To evaluate the feasibility and safety of administering surfactant via LMA as first-line therapy for infants 32–38 weeks GA with RDS in a community NICU, and to assess need for intubation, sedation, mechanical ventilation, and transfer.

Design/Methods: A pre- and post-implementation study was performed using retrospective chart review to evaluate management of infants ≥32 weeks GA with RDS. The team partnered with a regional level III NICU for education using a “train-the-trainer” model. Physicians, nurses, and respiratory therapists completed hands-on instruction with mannequins, videos, and competency validation. After staff training, clinical practice guidelines and data tracking tools were implemented, and prospective data were collected on subsequent cases.

Results: Pre-implementation: Fifteen infants with RDS (mean GA 34.5 weeks, mean BW 1,923 g) received surfactant via ETT after intubation and sedation. None qualified for early extubation, and all were transferred for ongoing care resulting in family separation. Twelve (75%) required one dose of surfactant and were extubated within 24 hours; three required two doses and prolonged ventilation.
Post-implementation: Six infants received surfactant via LMA without intubation or sedation. (Mean GA 36 weeks, mean BW 2838 gr). All remained stable on CPAP and avoided transfer. Three experienced brief bradycardia during LMA placement, responding to atropine. One infant sustained an esophageal perforation during nasogastric tube placement and recovered fully after evaluation at a tertiary center.

Conclusion(s): Surfactant administration via LMA is a safe, feasible, and effective way of treating RDS in moderately preterm infants within a community NICU. This approach eliminates the need for intubation, sedation, and transfer, allowing families to remain together while
reducing healthcare costs. Implementation in community settings can enhance neonatal respiratory care and support family-centered outcomes.