Less invasive surfactant administration for meconium aspiration syndrome.

BACKGROUND

The role of less invasive surfactant administration (LISA) using a thin catheter in the management of meconium aspiration syndrome (MAS) is unclear.

STUDY DESIGN

A retrospective study of infants with MAS admitted between January 2016 and December 2023. Relevant characteristics and outcomes were compared between a group of infants receiving surfactant in conjunction with mechanical ventilation (MV) via an endotracheal tube (ETT-surf) and receiving LISA. Infants intubated at birth were excluded.

RESULTS

Of the 113 infants admitted on continuous positive airway pressure (CPAP), 61 did not receive surfactant, 26 belonged to the ETT-surf group and 26 to the LISA group. Compared with the ETT-surf, a higher proportion of infants in the LISA group were exposed to chorioamnionitis and received a lower median fraction of inspired oxygen at birth and before surfactant therapy. Notably, infants in the LISA group had a lower need for MV (100 vs 23%, p<0.001), 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). A subgroup analysis of infants with hypoxic respiratory failure on admission showed lower need for MV and duration of hospital stay with the LISA group compared with the ETT-surf group.

CONCLUSIONS

LISA was associated with a lower need for MV, iNO and a shorter duration of hospital stay in a select group of infants with MAS. Further prospective studies are necessary to evaluate the role of LISA in MAS.