Supplementary Material for: Less-Invasive Surfactant Administration for Neonatal Respiratory Distress Syndrome: A Consensus Guideline

Introduction: Less-invasive surfactant administration (LISA) is a method of surfactant delivery to preterm infants for treating respiratory distress syndrome (RDS), which can reduce the composite risk of death or bronchopulmonary dysplasia and the time on mechanical ventilation. Methods: A systematic literature search of studies published up to April 2021 on minimally invasive catheter surfactant delivery in preterm infants with RDS was conducted. Based on these studies, with parental feedback sought via an online questionnaire, 9 UK-based specialists in neonatal respiratory disease developed their consensus for implementing LISA. Recommendations were developed following a modified, iterative Delphi process using a questionnaire employing a 9-point Likert scale and an a priori level of agreement/disagreement. Results: Successful implementation of LISA can be achieved by training the multidisciplinary team and following locally agreed guidance. From the time of the decision to administer surfactant, LISA should take <30 min. The comfort of the baby and requirements to maintain non-invasive respiratory support are important. While many infants can be managed without requiring additional sedation/analgesia, fentanyl along with atropine may be considered. Parents should be provided with sufficient information about medication side effects and involved in treatment discussions. Conclusion: LISA has the potential to improve outcomes for preterm infants with RDS and can be introduced as a safe and effective part of UK-based neonatal care with appropriate training.引言：微创肺表面活性物质给药法（Less-invasive surfactant administration, LISA）是一种向早产儿递送肺表面活性物质以治疗呼吸窘迫综合征（respiratory distress syndrome, RDS）的临床手段，该方法可降低死亡或支气管肺发育不良的复合风险，并缩短机械通气时长。 方法：本研究对截至2021年4月发表的、针对呼吸窘迫综合征早产儿采用微创导管递送肺表面活性物质的相关研究开展了系统性文献检索。基于上述研究成果，并通过在线问卷征集家长反馈，英国9名新生儿呼吸疾病专科医师就LISA的临床实施达成了共识。推荐意见经改良迭代德尔菲法制定，采用9分量李克特（Likert）量表问卷，并预设了同意/不同意的判定阈值。 结果：通过对多学科团队开展专项培训并遵循本地共识制定的操作指南，可成功实现LISA的临床应用。从决定给予肺表面活性物质之时起，LISA操作时长应控制在30分钟以内。患儿的舒适度以及维持无创呼吸支持的相关需求为核心考量因素。尽管多数患儿无需额外镇静/镇痛即可完成操作，但可考虑联合使用芬太尼与阿托品。应向家长充分告知药物不良反应相关信息，并邀请其参与治疗决策讨论。 结论：LISA有望改善呼吸窘迫综合征早产儿的临床预后，在接受适当培训的前提下，可作为英国新生儿护理中安全且有效的组成部分加以推广应用。