Efficacy of minimally invasive surfactant therapy in moderate and late preterm infants: A multicentre randomized control trial

Abstract

MIST for respiratory distress syndrome management in moderate and late preterm infants was associated with a significant reduction of MV exposure and pneumothorax occurrence.

Novel Surfactant Administration Techniques: Will They Change Outcome?

“…In three trials, infants who needed surfactant were given it via TCA or by InSurE or ET tube after intubation and mechanical ventilation [27-29]. Surfactant was not necessarily administered at the same threshold for the two groups as the threshold for intubation, including solely for surfactant administration, may have been different than that for brief endotracheal instrumentation by thin catheter.…”

“…Olivier et al [29] . In this randomized controlled trial in 12 NICUs in Canada, infants born at 32–36 weeks’ gestation who were stable on 6 cm H 2 O CPAP and FiO 2 ≥0.35 in the first 24 h of life were randomized to receive 100 mg/kg beractant either by a 5-Fr feeding tube (TCA group) ( n = 24) or after intubation and mechanical ventilation at the discretion of the attending neonatologist (standard group) ( n = 21).…”

“…In the meta-analysis of all four trials, there is no statistically significant decrease in mortality associated with TCA (LISA) (typical RR 0.75, 95% CI 0.44–1.30; typical RD –0.03, 95% CI –0.08 to 0.03). Two trials compared TCA to intubation and surfactant treatment [28, 29]. Neither of these trials separately reported a decrease in mortality, and the typical estimate does not support an effect on mortality from TCA (typical RR 0.99, 95% CI 0.52–1.89; typical RD 0.00, 95% CI –0.05 to 0.05).…”

“…Six trials reported on the effect of TCA on pneumothorax [23-25, 27-29]. Of the three studies that compared TCA to InSurE [23-25], none reported a decrease in pneumothorax, and the meta-analysis of the trials does not suggest an effect of TCA on the risk of pneumothorax (typical RR 0.82, 95% CI 0.41–1.62; typical RD 0.01, 95% CI –0.06 to 0.03).…”

“…Of the three studies that compared TCA to InSurE [23-25], none reported a decrease in pneumothorax, and the meta-analysis of the trials does not suggest an effect of TCA on the risk of pneumothorax (typical RR 0.82, 95% CI 0.41–1.62; typical RD 0.01, 95% CI –0.06 to 0.03). Three studies reported on TCA versus various strategies regarding intubation and later surfactant treatment [27-29]. Kribs et al [28] reported a marginal decrease in pneumothorax.…”