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

Chaitra Reddy Molugu; Molugu Hemanth Reddy; Ramisetti Manikanta

doi:10.18203/2349-3291.ijcp20263283

Authors

Chaitra Reddy Molugu Kamineni Academy of Medical Sciences and Research Centre, L. B. Nagar, Hyderabad, Telangana, India
Molugu Hemanth Reddy Apollo Institute of Medical Sciences and Research, Jubilee Hills, Film Nagar, Hyderabad, Telangana, India
Ramisetti Manikanta Konaseema Institute of Medical Sciences (KIMS), Chaitanya Health City, Amalapuram, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20263283

Keywords:

Respiratory distress syndrome, Preterm neonates, Less invasive surfactant administration, INSURE, Surfactant therapy, Non-invasive ventilation

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.

References

Sweet DG, Carnielli V, Greisen G, Hallman M, Klebermass-Schrehof K, Ozek E, et al. European consensus guidelines on the management of respiratory distress syndrome—2022 Update. Neonatology. 2023;120(1):3-23.

Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163(7):1723-9.

Polin RA, Carlo WA; Committee on Fetus and Newborn. Surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics. 2014;133(1):156-63.

Verder H, Albertsen P, Ebbesen F, Greisen G, Robertson B. Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks' gestation. Pediatrics. 1999;103(2):562.

Sweet DG, Carnielli V, Greisen G, Hallman M, Klebermass-Schrehof K, Lavizzari A, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2025. Neonatology. 2026;123(4):514-39.

Dunn MS, Kaempf J, de Klerk A, de Klerk R, Reilly M, Howard D, et al. Vermont Oxford Network DRM Study Group. Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates. Pediatrics. 2011;128(5):1069-76.

Aldana-Aguirre JC, Pinto M, Featherstone RM, Kumar M. Less invasive surfactant administration versus intubation for surfactant delivery in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal. 2017;102(1):529.

Lau CSM, Chamberlain RS, Sun S. Less invasive surfactant administration reduces the need for mechanical ventilation in preterm infants: a meta-analysis. Glob Pediatr Health. 2017;4:276966.

Isayama T, Iwami H, McDonald S, Beyene J. Association of noninvasive ventilation strategies with mortality and bronchopulmonary dysplasia among preterm infants: a systematic review and meta-analysis. JAMA. 2016;316(6):611-24.

Silveira RC, Panceri C, Muñoz NP, Carvalho MB, Fraga AC, Procianoy RS. Less invasive surfactant administration versus intubation-surfactant-extubation in the treatment of neonatal respiratory distress syndrome: a systematic review and meta-analyses. J Pediatr (Rio J). 2024;100(1):8-24.

Dargaville PA, Kamlin COF, Orsini F, Wang X, De Paoli AG, Kanmaz Kutman HG, et al. OPTIMIST-A Trial Investigators. Effect of minimally invasive surfactant therapy vs sham treatment on death or bronchopulmonary dysplasia in preterm infants with respiratory distress syndrome: the OPTIMIST-A randomized clinical trial. JAMA. 2021;326(24):2478-87.

Sun X, Yarza S, Kuang Y, Sharma S, Uyei J, Khalid S, Fuentes D. Safety of less invasive surfactant administration in preterm infants: a meta-analysis. Pediatr Pulmonol. 2026;61(7):67.

Sabzehei MK, Basiri B, Shokouhi M, Ghahremani S, Moradi A. Comparison of minimally invasive surfactant therapy with intubation-surfactant administration and extubation for treating preterm infants with respiratory distress syndrome: a randomized clinical trial. Clin Exp Pediatr. 2022;65(4):188-93.

Moschino L, Ramaswamy VVR, Reiss IKM, Baraldi E, Roehr CC, Simons SHP. Sedation for less invasive surfactant administration in preterm infants: a systematic review and meta-analysis. Pediatr Res. 2023;93(3):471-91.

Kesler H, Lohmeier K, Hoehn T, Kribs A, Peinemann F. Thin-catheter Surfactant Application for Respiratory Distress Syndrome in Spontaneously Breathing Preterm Infants: A Meta-analysis of Randomized Clinical Trials. Curr Pediatr Rev. 2022;18(4):286-300.

Kaleem A, Haroon F, Fatima B, Victor G, Qadir M, Waheed KAI. Efficacy and safety of surfactant administration by MIST and INSURE techniques in Neonates with Respiratory Distress Syndrome: A randomized controlled trial. Pak J Med Sci. 2023;39(3):848-52.