541 - Integrating Laryngeal Mask with Routine Surfactant Administration Practices in a Regional NICU

Publication Number: 3522.541

Joaquim Pinheiro, Albany Medical College, Albany, NY, United States; Jennifer Nichols-Martin, Albany Medical College, Albany, NY, United States; Lesa A. Ward, Bernard Millie Duker Childrens Hospital, Rotterdam, NY, United States; Chad J.. Pezzano, Albany Medical College, Albany, NY, United States; Anshu Paul, Albany Medical College, Albany, NY, United States

Background: Current recommendations for surfactant in managing respiratory distress syndrome (RDS) suggest avoiding invasive ventilation during and after instillation. Most NICUs are implementing approaches to surfactant delivery that involve thin catheters (MIST/LISA) or laryngeal mask (LM) airways as alternatives to tracheal intubation (ETT). After demonstrating non-inferiority of LMA vs. ETT surfactant delivery in 2 randomized trials, the route of rescue surfactant therapy in our NICU has relied on individual clinicians' discretion, taking into consideration infant and available device sizes, plus staff and family preferences.

Objective: 1) To characterize the adoption of laryngeal mask devices for surfactant treatment in routine NICU care, in a post-trial era; 2) to compare current outcomes of LM with those observed under clinical trial conditions; 3) to assess the spread of LM use to conditions other than RDS.

Design/Methods: Retrospective review of surfactant usage in the level IV NICU at Albany Medical Center between September 2021 and September 2025. Descriptive statistics were used to compare the frequency of surfactant administration via LM or ETT and corresponding patient characteristics. We tracked concurrent of LM usage in NICU or delivery room, for conditions other than RDS.

Results: 641 neonates received surfactant therapy, 29% as prophylaxis (1 via LM), 71% as rescue. Surfactant was given via LM to 33% of all neonates (62% of those weighing > 1500 g). Frequency of LM use in RDS increased from 2 per quarter to a high of 23 per quarter. Figure 1 shows indications for the 280 LM insertions in 244 neonates, including surfactant therapy for meconium aspiration syndrome, and difficult airway, but only 3 for DR resuscitation and 1 for palliative care. Table 1 shows characteristics and outcomes of newborns with RDS managed by LM compared to those initially receiving surfactant via ETT or MIST. LM insertions were performed by a variety of clinicians, trainees and students. Minor complications, primarily blood noted on the LM surface, occurred in 2% of insertions.

Conclusion(s): LM is increasingly chosen by clinicians in our NICU, mostly for surfactant administration. We observed high effectiveness and no significant complications, further strengthening the evidence derived from our clinical trials. The procedure is well tolerated by neonates, despite being frequently performed by supervised trainees. Further work will identify opportunities for appropriate expansion of LM use in our population, focusing on earlier treatment to minimize pneumothorax risk, and on promoting LM use in delivery room resuscitation.

Figure 1. Indications for LMA use
Indications for LMA use in 244 neonates undergoing 280 insertions, Sept 2021- Sept 2025

Figure 2. Characteristics of neonates receiving surfactant via LMA compared with ETT or thin catheter (MIST)
Characteristics of neonates with RDS given surfactant via LMA