106 Assessing the introduction of Minimally Invasive Surfactant Therapy (MIST) in the neonatal intensive care units of a Canadian teaching hospital
Bibliographic record
Abstract
Abstract Background Exogenous surfactant replacement therapy is an established treatment for respiratory distress syndrome (RDS), reducing both morbidity and mortality in preterm infants. Historically, surfactant has been administered via endotracheal tube with a subsequent period of mechanical ventilation, which is often deleterious to lung health. Although new methods of minimally invasive surfactant therapy (MIST) administration have been developed, data on the implementation of these strategies in Canada remain limited. Objectives Our objective was to describe clinical and safety outcomes associated with the introduction of MIST into standard of care at two neonatal care units in a large Canadian teaching hospital. Design/Methods A retrospective chart review of MIST procedures completed between March 1 2020 and December 31 2023 collected clinical and procedural data, medication use and adverse events. Demographic data and subsequent clinical outcomes were collected from medical records. The proportions of the patients who avoided mechanical ventilation within 72 hours post-MIST, the success of the MIST procedure and safety outcomes were described. An exploratory analysis was performed to investigate the associations of gestational age (GA), age at procedure and steroid use with the need for mechanical ventilation within 72 hours. Results A total of 127 infants received surfactant via MIST, including 36 with a GA < 29 weeks. The median GA was 31 weeks (interquartile range [IQR]: 28.4, 33.6), median birth weight was 1630 grams (IQR: 1107.5, 2206.5) and median age at MIST procedure was 5 hours (IQR: 3.0, 19.5). Rate of MIST success was 91.3%. Of the 38 patients (29.9%) requiring mechanical ventilation within 72 hours, 16 (17.5%) had a GA ≥ 29 weeks and 22 patients (61.1%) had a GA < 29 weeks. Overall, GA was correlated with reduced need for intubation and mechanical ventilation at 72 hours (odds ratio [OR]: 0.76, p < 0.001). Desaturation was the most common adverse effect (61%); apnea or chest freeze were observed in 8% of patients. The profile of adverse effects was similar for GA < 29 weeks and those ≥ 29 weeks. Overall, median GA decreased with each study year, from 33 weeks to 30 weeks, suggesting increased comfort in the procedure with smaller babies. Conclusion MIST was successfully introduced as the standard of care into our neonatal units, avoiding intubation and mechanical ventilation within 72 hours in about 70% of patients. Additionally, a higher GA was associated with a lower chance of needing mechanical ventilation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".