Ellen de Kort

54 Chapter 4 METHODS Study design and patients We conducted a prospective monocentric observational study on the level III neonatal intensive care unit (NICU) at Máxima Medical Center Veldhoven, the Netherlands, between January 2016 and February 2018. Patients <32 weeks’ gestation were included in the study if they had RDS and were treated with LISA. We only included every first LISA procedure per patient. LISA for treatment of RDS was implemented into daily practice in our department in 2014 and is since then standard of care. LISA is performed in infants with a gestational age (GA) less than 32 weeks with clinical signs of RDS, respiratory support with nasal CPAP with a positive end-expiratory pressure of at least 6 cm H 2 O, and an oxygen requirement of 30% or more to maintain SpO 2 levels between 88 and 95%. Description of the LISA procedure LISA procedures were performed according to a local standardized protocol. Prior to LISA, patients received a loading dose of caffeine to support the respiratory drive. A dose of atropine 10 μg/kg was administered 5 to 10 min before start of the procedure to prevent reflex bradycardia during laryngoscopy and catheter placement. About 1 to 2 minutes before start of the procedure, sucrose 20% (0.1 ml/kg) was administered in the cheek pouch and facilitated tucking was applied. During the procedure, swaddling was performed to contain the infant and promote comfort. Sedative premedication was not used. A laryngoscope was then used for visualization of the vocal cords and placement of the catheter. At the start of the study we used a 5F umbilical catheter which was placed between the vocal cords with the use of a Magyll forceps. During the study we started to use a shorter and stiffer LISA catheter (Chiesi Pharmaceuticals, Parma, Italy), for which the use of a Magyll forceps was no longer needed. After placement of either catheter, surfactant (Curosurf, 150–200mg/kg) was instilled over a period of 1–3 minwhile the patient was spontaneously breathing on nasal CPAP. During surfactant instillation, aspiration was done via the nasogastric tube to check for surfactant spill. After surfactant instillation was complete, the catheter was immediately removed. Data collection We collected the following patient characteristics: gestational age, birthweight, postnatal age at the LISAprocedure and gender. Data regarding starting time of the LISAprocedure, the quality of technical conditions using a standardized scale, the number of attempts, reasons for failed attempts, and function of the operator of the procedure were collected during and immediately after the procedure on a standardized registration form.