742 - LISA in Action: Implementation and Real-World Performance of Less-Invasive Surfactant Administration in a Level IV NICU

Publication Number: 1718.742

Sara Manetta, University of Virginia School of Medicine, Charlottesville, VA, United States; Santina Zanelli, University of Virginia, Charlottesville, VA, United States; Jaclyn Wiggins, University of Virginia School of Medicine, Charlottesville, VA, United States

Background: Over the past decade, surfactant delivery has shifted toward less-invasive techniques to reduce lung injury in preterm infants, evolving from INtubation-SURfactant-Extubation (INSURE) to Less-Invasive Surfactant Administration (LISA). LISA delivers surfactant via a thin catheter while maintaining spontaneous breathing on non-invasive respiratory support, and avoiding positive pressure and mechanical ventilation (MV). Compared to INSURE, LISA has been associated with lower intubation rates, reduced MV and bronchopulmonary dysplasia, and shorter hospitalizations. Our Level IV NICU introduced LISA in 2020. This study describes our institutional experience and establishes a baseline for future quality-improvement efforts.

Objective: To describe LISA use, success, and outcomes at a single Level IV NICU.

Design/Methods: We retrospectively reviewed infants >24 weeks' gestation admitted between January 2018 and October 2024 who received at least one surfactant dose, excluding those intubated in the delivery room. Patients were grouped by first-intention surfactant administration method: intubation, INSURE, and LISA. Outcomes included intubation, time from surfactant to intubation, days on ventilation and oxygen, need for oxygen at 36 weeks' postmenstrual age (PMA), dexamethasone, tracheostomy, home respiratory support, mortality, and length-of-stay. LISA success rate and the number of attempts were analyzed.

Results: We reviewed 307 infants who received surfactant via intubation (N=94), INSURE (N=105), and LISA (N=108). Overall median gestational age was 32.0 weeks. Groups had similar demographics except for higher initial respiratory support in the intubation group (p=0.004; Table 1). No significant differences were found in short-term outcomes, including in post-hoc subgroup analysis of infants >28 weeks' gestation. While not statistically different, median length-of-stay was 33.5 days in the LISA group compared to 37.0 days in the INSURE group (Table 2). LISA had a 77% success rate. LISA had a 67% first-pass success rate, and required an average of 2.2 attempts per success (Figure 1), compared with 60% and 1.7 attempts for intubation, and 41% and 2.3 attempts for INSURE.

Conclusion(s): LISA can be effectively implemented in preterm infants >24 weeks' gestation with a 77% success rate. In this cohort, while short-term outcomes did not differ significantly from INSURE, a trend toward shorter hospitalization was observed. These findings highlight opportunities to improve performance through structured training and standardized practice.

Table 1. Patient Demographics by Surfactant Administration Method
Patient demographics grouped by surfactant administration method. Categorical variables are summarized as N (%) and continuous variables as median (IQR). Groups were compared using Kruskal-Wallis rank sum tests, Pearson's Chi-squared tests and Fisher exact tests. *indicates p-values of statistical significance ( <0.05).

Table 2. Patient Outcomes Comparing INSURE versus LISA
Patient outcomes comparing INSURE versus LISA surfactant administration method. Categorical variables are summarized as N (%) and continuous variables as median (IQR). Groups were compared using Kruskal-Wallis rank sum tests, Pearson's Chi-squared tests and Fisher's exact tests.

Figure 1. Run Charts of LISA Success and Attempts
Run charts of LISA success (1A), number of attempts (1B), and first-pass successes (1C) over time by patient groupings. 1A and 1B included all LISA occurrences regardless of success, while 1C included only successful LISA. Charts 1A and 1C were grouped by 3 occurrences per patient group. Chart 1B was grouped by number of successes. "Success" was defined as the administration of surfactant without need to abort the procedure or convert to another method, "attempt" as number of laryngoscope blade passes for successful surfactant administration, and "first-pass success" as successful surfactant administration with first blade pass.