LISA vs InSurE in Preterm Respiratory Distress Syndrome : A Three-Year Experience at Windsor Regional Hospital NICU (WRH)

Respiratory distress syndrome (RDS) is a leading cause of morbidity in preterm infants due to insufficient surfactant production. Surfactant therapy is the standard of care, with two primary administration methods: Less Invasive Surfactant Administration (LISA) and INtubation-SURfactant-Extubation (INSURE). This study compares the efficacy of these methods in a Level II community neonatal intensive care unit (NICU). A retrospective chart review was conducted on preterm infants (<34 weeks gestation) who received surfactant between 2021 and 2023. The primary outcome measure was incidence of intubation within first 7 days of life, and secondary outcome measures were number of surfactants administered, as well as # of days of hospitalization and # of days on any type of respiratory support. LISA usage trends were also analyzed as part of a local quality improvement initiative. A total of 28 infants (9 in Insure and 19 in LISA) were included. The need for intubation was lower in the LISA group (16%) compared to INSURE (22%). LISA was associated with a slightly higher number of surfactant doses but a shorter hospitalization and respiratory support duration, though these differences were not statistically significant. Regarding LISA usage, all eligible infants (6/6) received surfactant via LISA in 2021; however, usage declined significantly in 2022 (5/11), followed by a rebound in 2023 (8/12). LISA may reduce the incidence of mechanical ventilation in spontaneously breathing preterm infants without significantly affecting hospitalization length or surfactant needs. Further data collection and staff education initiatives are necessary to enhance LISA adoption and improve neonatal outcomes.