Less Invasive Surfactant Administration (LISA) using Video Laryngoscopy in Late Preterm Babies in a District General Hospital in The UK

Background: Less invasive surfactant administration (LISA) has become an increasingly used intervention in the treatment of respiratory distress syndrome in neonates [1]. Previous reports and meta-reviews document positive outcomes in the avoidance of mechanical ventilation as well as reduction in bronchopulmonary dysplasia [2,3]. During the last few years video laryngoscopes have become available for neonatal practice. The use of video assisted visualisation of the vocal cords makes application of surfactant via LISA easy and safe.

Objective: We report 15 babies who received surfactant using LISA in combination with video laryngoscopy in a District General Hospital in the UK between March and December 2018.

Methods: Babies had a mean gestational age of 34 weeks, with a range of 31 to 39 weeks. Indication for the administration of surfactant was increasing oxygen requirement, clinical impression of respiratory distress and rising capillary CO2 levels. All babies tolerated the procedure well with improvement in oxygen requirement, clinical assessment of respiratory distress and capillary CO2. There were no significant adverse effects. 3 babies were given atropine following procedure induced mild bradycardia. None of the babies were sedated.

Conclusion: Our experience with delivering surfactant using LISA assisted by video laryngoscopy has been very positive. The use of a video laryngoscope allows less experienced operators to visualise the vocal cords safely under supervision [4]. This has a positive impact on the team as well as a valuable learning benefit. 6 out of 7 doctors performing the procedure felt that the video laryngoscope had improved their confidence and allowed the procedure to be performed less invasive compared to routine laryngoscopy techniques.