372 - Can minimally invasive surfactant therapy (MIST) be introduced safely in a Level 3 NICU?

Publication Number: 372.4435

Krystin K. Wong, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States; Chieko Kimata, Hawaii Pacific Health, Honolulu, HI, United States; Sheree Kuo, University of Hawaii, Honolulu, HI, United States

Background: Minimally invasive surfactant therapy (MIST) is an alternate method for surfactant delivery that allows for spontaneous breathing and continuous nasal positive pressure support during treatment. Following participation in the OPTIMIST trial (Dargaville [JAMA. 2021;326(24):2478–2487. doi:10.1001/jama.2021.21892]), our neonatal intensive care unit (NICU) introduced MIST as an option for surfactant administration, liberalizing patient eligibility (gestational age and treatment timing).

Objective: The objective of this study was to determine whether MIST could be safely adopted as a method of surfactant administration in our level 3 NICU.

Design/Methods: In this retrospective study, we examined all patients in the NICU at Kapiolani Medical Center (KMC) who were treated with MIST from Sept 2021-Sept 2024. Patients were divided into two groups: < 29 weeks (wk) gestation and ≥ 29 wk gestation at birth. In addition to demographic data, procedural and safety outcomes were collected. The composite outcome of death or bronchopulmonary dysplasia (BPD) at 36 wk postmenstrual age (PMA) was assessed in patients born < 29 wk gestation and compared to that of the OPTIMIST cohort (25 0/7-28 6/7wk). Data was analyzed using descriptive statistics, Student’s t-test, Fisher’s exact testing and Mann-Whitney test where appropriate.

Results: A total of 147 out of 151 attempts to administer MIST were successful in 133 patients. Fourteen patients received treatment twice with MIST. All four failed attempts were due to inability to properly place the MIST catheter. Patients in both KMC subgroups were significantly older and heavier at birth than the MIST group (Table 1). Rates of successful MIST administration were similar for the KMC < 29 wk (98.3%) and OPTIMIST groups (100%)(Table 2). MIST administration was less successful in the KMC ≥ 29 wk group (96.9%, P=0.02). However, when MIST was administered, the KMC ≥ 29wk group had less procedural complications. Lastly, the KMC < 29 wk group had similar rates of death or BPD at 36 weeks’ PMA, pneumothorax requiring drainage and major morbidities when compared to the OPTIMIST cohort (Table 3).

Conclusion(s): For KMC patients born < 29 wk who received MIST, rates of procedural complications, major morbidities, and death were similar to previously published results. For KMC patients born ≥ 29 wk, MIST administration was less successful due to inability to place the MIST catheter, yet otherwise better tolerated than in the OPTIMIST trial. We postulate that tools such as video laryngoscopy and judicious use of sedation may improve catheter placement rates in larger newborns.

Table 1. Patient Demographics
Asterisk (*) indicates significant difference between sub-group and OPTIMIST cohort (P < or =0.05)

Table 2. MIST Procedure and Safety Outcomes
Asterisk (*) indicates significant difference between sub-group and OPTIMIST cohort (P < or =0.05)

Table 3. Major Morbidities and Death in < 29 wk Patients