106 Assessing the introduction of Minimally Invasive Surfactant Therapy (MIST) in the neonatal intensive care units of a Canadian teaching hospital

Abstract Background Exogenous surfactant replacement therapy is an established treatment for respiratory distress syndrome (RDS), reducing both morbidity and mortality in preterm infants. Historically, surfactant has been administered via endotracheal tube with a subsequent period of mechanical ventilation, which is often deleterious to lung health. Although new methods of minimally invasive surfactant therapy (MIST) administration have been developed, data on the implementation of these strategies in Canada remain limited. Objectives Our objective was to describe clinical and safety outcomes associated with the introduction of MIST into standard of care at two neonatal care units in a large Canadian teaching hospital. Design/Methods A retrospective chart review of MIST procedures completed between March 1 2020 and December 31 2023 collected clinical and procedural data, medication use and adverse events. Demographic data and subsequent clinical outcomes were collected from medical records. The proportions of the patients who avoided mechanical ventilation within 72 hours post-MIST, the success of the MIST procedure and safety outcomes were described. An exploratory analysis was performed to investigate the associations of gestational age (GA), age at procedure and steroid use with the need for mechanical ventilation within 72 hours. Results A total of 127 infants received surfactant via MIST, including 36 with a GA < 29 weeks. The median GA was 31 weeks (interquartile range [IQR]: 28.4, 33.6), median birth weight was 1630 grams (IQR: 1107.5, 2206.5) and median age at MIST procedure was 5 hours (IQR: 3.0, 19.5). Rate of MIST success was 91.3%. Of the 38 patients (29.9%) requiring mechanical ventilation within 72 hours, 16 (17.5%) had a GA ≥ 29 weeks and 22 patients (61.1%) had a GA < 29 weeks. Overall, GA was correlated with reduced need for intubation and mechanical ventilation at 72 hours (odds ratio [OR]: 0.76, p < 0.001). Desaturation was the most common adverse effect (61%); apnea or chest freeze were observed in 8% of patients. The profile of adverse effects was similar for GA < 29 weeks and those ≥ 29 weeks. Overall, median GA decreased with each study year, from 33 weeks to 30 weeks, suggesting increased comfort in the procedure with smaller babies. Conclusion MIST was successfully introduced as the standard of care into our neonatal units, avoiding intubation and mechanical ventilation within 72 hours in about 70% of patients. Additionally, a higher GA was associated with a lower chance of needing mechanical ventilation.