374 - Less Invasive Surfactant Administration for Meconium Aspiration Syndrome: A retrospective cohort study

Publication Number: 374.5712

Arun Prasath, UT Southwestern Medical Center, Dallas, TX, United States; Etze Chotzoglou, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; Asmahan Ahmed, Universty of Texas SouthWestern, Dallas, TX, United States; Efren Diaz, University of Texas Southwestern Medical School, Desoto, TX, United States; Patti J. Burchfield, University of Texas Southwestern Medical School, Dallas, TX, United States; L. Steven Brown, Parkland Health, Dallas, TX, United States; David B. Nelson, University of Texas Southwestern Medical School, Dallas, TX, United States; Katherine A. Stumpf, UTSW-Dallas, Dallas, TX, United States; Venkatakrishna Kakkilaya, UT Southwestern Medical Center, Dallas, TX, United States

Background: CPAP ( Continuous positive airway pressure) is effective as a primary modality of support and decreases the need for mechanical ventilation (MV) in infants with meconium aspiration syndrome (MAS). Surfactant therapy as a treatment for MAS has been evaluated in several trials and proven to reduce morbidity. It is unclear whether infants with MAS supported on CPAP would benefit from less invasive surfactant administration (LISA)

Objective: To evaluate the role of LISA in infants admitted to the neonatal intensive care unit (NICU) on CPAP. We hypothesize that LISA decreases the need for MV in infants with MAS compared to the conventional management strategy of surfactant administration via endotracheal tube (ETT) in conjunction with MV.

Design/Methods: Single-center retrospective study of infants ≥ 35 weeks GA, born between January 2016-December 2023 and diagnosed with MAS. All infants ≥35 weeks GA with a diagnosis of MAS were identified from the validated NICU database and confirmed by accessing individual patient electronic medical records (EMR) were included except those who were intubated in the delivery room (DR). A subgroup analysis was conducted to compare between the group of infants received (Surf group) and did not receive surfactant (No-surf group) using analysis of variance (ANOVA), Kruskal-Wallis or Dunn test, two-sample t-test, the Mann Whitney U test, and the χ2 test, depending on the distribution of variables.

Results: Of the 113 infants admitted on CPAP, 61 did not receive surfactant, 26 belonged to ETT-surf, and 26 to the LISA group. Compared to the ETT-surf, a higher proportion of infants in the LISA group were exposed to chorioamnionitis. (Table 1) However, LISA group infants received a lower median fraction of inspired oxygen at birth and before surfactant therapy and a lower alveolar-arterial oxygen gradient. Notably, LISA group infants had a lower need for mechanical ventilation (MV) (100 vs. 23%, P < 0.001) and inhaled nitric oxide (iNO) (46 vs. 12 %, P = 0.01) and a shorter median duration of hospital stay (14 vs. 24 days, P = 0.04). (Table 3). We also compared the infants who were treated with surfactant for MAS vs infants who did not receive surfactant. (Figure 3: Table 4-6)

Conclusion(s): In conclusion, our study shows that LISA is associated with decrease in need for MV and iNO and shorter duration of hospital stay in a select group of infants with MAS, admitted on non-invasive respiratory support. This study shows that LISA is feasible in the management of MAS. The findings of this study should be confirmed in larger prospective trials.

Figure 1: Study methodology


Table 1-3: Comparison of baseline characteristics and outcomes in ETT-Surf and LISA groups


Table 4-6: Comparison of baseline characteristics and outcomes Surf and NO surf groups