543 - LISA 2.0: Evolution of a LISA Protocol

Publication Number: 3524.543

Tynisha Koenigsaecker, UH Rainbow Babies & Children's Hospital, Shaker Heights, OH, United States; Stephanie Martinez, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States; Shreya Patel, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States; Kevin Ives, UH Rainbow Babies & Children's Hospital, Berea, OH, United States; Bodie A. Julie, UH Rainbow Babies & Children's Hospital, Chesterland, OH, United States; Chad e. Weagraff, UH Rainbow Babies & Children's Hospital, Avon, OH, United States; Monika Bhola, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States; Rita M.. Ryan, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States

Background: We have been delivering surfactant via less-invasive surfactant administration (LISA) in our neonatal intensive care unit (NICU) since 2020 and published our startup strategy then for other NICU providers starting LISA. We have since delivered surfactant via LISA 388 times to infants ranging from 25 to 36 6/7 weeks (w) gestational age (GA). We have continued to collect and monitor our own data as well as review related literature to continuously improve our LISA practice.

Objective: The purpose of this project is to share the continued changes we have made to help other NICU providers fine-tune their LISA practice.

Design/Methods: Our general LISA criteria include babies with GA 25-35 6/7w, on > 21% O2, on ≥CPAP +6, pCO2 < 70 if a blood gas was obtained, and radiographic and/or clinical evidence of respiratory distress syndrome. The changes we have made (Table 1) include increasing the minimum CPAP requirement prior to LISA to +6, flagging the LISA catheter to ensure appropriate depth, introducing video laryngoscopy, reinforcing use of sucrose sedation and swaddling, adding Downes scoring criteria, lowering the GA limit for LISA from 27w to 25w, and mandatory surfactant administration based on GA. Specific data were examined before and after each change.

Results: We attempted LISA on 399 babies (Table 2) and the procedure was successful on 388 (97%). Of the babies who received LISA, overall 18% "failed", (i.e., required intubation within the first 7 days after LISA). As expected, the LISA failure rate was significantly higher in the babies < 28w. Additionally, our number of LISA attempts trended higher as gestational age increased. Reinforcement of the use of sucrose sedation and swaddling prior to procedure resulted in fewer attempts for successful LISA. Introduction of Downes scoring resulted in an increase in the number of infants with LISA failure by 9.4% indicating likely prior over-treatment. The rate of grade 2/3 BPD or death decreased in babies receiving LISA from 39% to 24% in babies < 28w. Finally, implementing mandatory surfactant for all infants < 28w resulted in surfactant being delivered significantly earlier in this population.

Conclusion(s): Overall, the changes we made have resulted in fewer attempts for successful LISA administration, reduced over-treatment with surfactant, reduced grade 2/3 BPD or death in infants < 28w and earlier surfactant administration. We hope this information can be of use as other NICUs either implement LISA or continue to fine-tune their practice.

Table 1
Rationale and changes made to our LISA protocol between the years 2020 and 2025 as well as the results of the changes made

Table 2
Demographics of infants on whom LISA was attempted as well as general statistics for the group