BOVINE LIPID EXTRACT SURFACTANT (BLES®) ADMINISTRATION USING A MINIMALLY INVASIVE APPROACH

Abstract BACKGROUND There is growing evidence that surfactant delivery via a thin endotracheal catheter during spontaneous breathing; a technique called minimally invasive surfactant therapy (MIST) is an alternative to intubation and surfactant administration. The majority of studies evaluating the MIST technique have utilized a higher concentration; lower volume surfactant at a dose of 2.5ml/kg. Little evidence is available describing the feasibility of administering a lower concentration, larger volume surfactant at a dose of 5ml/kg utilizing the MIST technique. OBJECTIVES To describe the feasibility of utilizing Bovine Lipid Extract Surfactant (BLES®) with the MIST technique within a single tertiary centre after a change in practice. DESIGN/METHODS A guideline for surfactant administration (BLES® – 5 ml/kg) using the MIST technique was developed in our centre in 2016. Infants with a birth weight ≥ 1000 g and ≥28 weeks gestation were deemed eligible candidates for this technique if they developed RDS and met criteria for surfactant administration (FiO2 requirement greater than 40% on nasal continuous positive airway pressure (NCPAP) and were clinically well apart from respiratory distress. Surfactant was administered via a thin catheter (KimVent® Multi-Access Catheter) which was inserted into the trachea using Magill forceps, while the baby continued to breathe spontaneously on NCPAP. Depth of catheter insertion was estimated using 6 cm + weight in kg. Surfactant was instilled into the trachea over 1–3 minutes and the delivery was timed to coincide with inspiration. Administration of sucrose was recommended and of atropine was optional prior to laryngoscopy for insertion of the endotracheal catheter. RESULTS Since implementation of the new guidelines, a total of 22 infants received surfactant by the MIST method. The mean gestational age was 32 ± 2.6 weeks and mean birth weight was 1972 ± 788g. Five infants (22.7%) had transient bradycardia and desaturations during the procedure. Five infants (22.7%) required intubation post MIST procedure at variable times (range 6–29 hours), 3 infants (14%) for increasing oxygen requirements and a second dose of surfactant and 2 (9%) infants for hypercapnia and poor respiratory drive. Twenty infants (90%) were successfully weaned to 21% oxygen on NCPAP post procedure at a median duration of 0.5 (range 0.01–29) hours. CONCLUSION The delivery of BLES® using the MIST technique for RDS was overall well tolerated by the patients and shown to be an effective alternative to more invasive methods.