Comparison of INSURE and LISA techniques in preterm neonates with respiratory distress

Abstract

Background: Respiratory distress syndrome (RDS) is a major cause of morbidity in preterm neonates. Aim of the study is to compare respiratory outcomes, procedure-related complications, neonatal morbidities, and hospitalization outcomes following surfactant administration by Less Invasive Surfactant Administration (LISA) versus INSURE in preterm neonates with RDS. Methods: This comparative clinical cohort study included 100 preterm neonates diagnosed with RDS. Fifty neonates received surfactant by LISA and 50 by INSURE. In the LISA group, surfactant (200 mg/kg) was administered through a 5F thin catheter while spontaneous breathing was maintained on non-invasive respiratory support. In the INSURE group, surfactant was administered following endotracheal intubation, followed by positive-pressure ventilation and extubation. Demographic characteristics, respiratory outcomes, procedure-related complications, neonatal morbidities, and duration of respiratory support and hospitalization were compared. Results: Mean gestational age was 30.35±3.12 weeks in the LISA group and 31.50±4.26 weeks in the INSURE group (p=0.127), and mean birth weight was 1952.8±750.92 g and 1968.5±850.88 g, respectively (p=0.956). Desaturation during surfactant administration was significantly less frequent with LISA than INSURE (20% vs. 40%; p=0.029). LISA also showed lower rates of intubation within 72 hours, mechanical ventilation, repeat surfactant administration, and several neonatal complications, although these differences were not statistically significant. Hospital stay was significantly shorter with LISA (9.1±2.1 vs. 12.6±3.2 days; p<0.001). Conclusion: LISA was associated with significantly less procedure-related desaturation and shorter hospitalization than INSURE. LISA may be a feasible alternative for surfactant administration in spontaneously breathing preterm neonates with RDS.