Impact of Minimally Invasive Surfactant Therapy in Preterm Infants at 29-32 Weeks Gestation

Dargaville, Peter A.; Ali, Sanoj K. M.; Jackson, Hamish; Williams, Christopher S.; Paoli, Antonio G De

doi:10.1159/000480066

Cited by 42 publications

(67 citation statements)

References 24 publications

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“…MIST also showed a slightly impaired surfactant distribution in the lungs compared with surfactant via endotracheal intubation 22. In line with our results, Dargaville repeatedly discussed the possible dose–effect relation on MIST success 1 23. He observed 100% MIST success in all preterm infants who received a 200 mg/kg dose of surfactant 1.…”

Section: Discussionsupporting

confidence: 88%

Minimally invasive surfactant therapy failure: risk factors and outcome

Janssen

Spil

Kaam

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo evaluate incidence of minimally invasive surfactant therapy (MIST) failure, identify risk factors and assess the impact of MIST failure on neonatal outcome.DesignRetrospective cohort study. MIST failure was defined as need for early mechanical ventilation (<72 hours of life). Multivariate logistic regression analysis was performed to identify risk factors for MIST failure and compare outcomes between groups.SettingTwo tertiary neonatal intensive care centres in the Netherlands.PatientsInfants born between 24 weeks’ and 31 weeks’ gestational age (GA) (n=185) with MIST for respiratory distress syndrome.InterventionsMIST procedure with poractant alfa (100–200 mg/kg).Main outcome measuresContinuous positive airway pressure (CPAP) failure after MIST in the first 72 hours of life.Results30% of the infants failed CPAP after MIST. In a multivariate logistic regression analysis, four risk factors were independently associated with failure: GA <28 weeks, C reactive protein ≥10 mg/L, absence of antenatal corticosteroids and lower surfactant dose. Infants receiving 200 mg/kg surfactant had a failure rate of 14% versus 35% with surfactant dose <200 mg/kg. Mean body temperature was 0.4°C lower at neonatal intensive care unit admission and before the procedure in infants with MIST failure.Furthermore, MIST failure was independently associated with an increased risk of severe intraventricular haemorrhage.ConclusionWe observed moderate MIST failure rates in concordance with the results of earlier studies. Absence of corticosteroids and lower surfactant dose are risk factors for MIST failure that may be modifiable in order to improve MIST success and patient outcome.

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Section: Discussionsupporting

confidence: 88%

Minimally invasive surfactant therapy failure: risk factors and outcome

Janssen

Spil

Kaam

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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“…However, endotracheal intubation has harmful effects including, bradycardia and hypotension in infants . Newer minimally invasive strategies for surfactant therapy have been reported and provide an intriguing option to manage RDS . These techniques incorporate the utilization of a small catheter placed in the trachea to administer surfactant.…”

Section: Introductionmentioning

confidence: 99%

“…Nearly half of the preterm babies (<34 weeks) with respiratory distress syndrome (RDS) managed on continuous positive airway pressure (CPAP) require surfactant administration via endotracheal tube intubation. 1 However, endotracheal intubation has harmful effects including, bradycardia and hypotension in infants. 2 Newer minimally invasive strategies for surfactant therapy have been reported and provide an intriguing option to manage RDS.…”

Section: Introductionmentioning

confidence: 99%

“…2 Newer minimally invasive strategies for surfactant therapy have been reported and provide an intriguing option to manage RDS. [1][2][3][4] These techniques incorporate the utilization of a small catheter placed in the trachea to administer surfactant. This not only avoids intubation but also allows CPAP to continue, thus maintaining constant functional residual capacity (FRC) of the preterm lung.…”

Section: Introductionmentioning

confidence: 99%

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Surfactant therapy in premature babies: SurE or InSurE

Jena

Bains

Pandita

et al. 2019

Pediatric Pulmonology

115

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Background: Preterm infants with respiratory distress syndrome (RDS) requiring surfactant therapy have been traditionally receiving surfactant by intubation surfactant and extubation technique (InSurE), which comprises of tracheal intubation, surfactant administration, and extubation. However, more recently noninvasive methods like least invasive surfactant therapy or minimally invasive surfactant therapy have been reported to be successful. These methods, avoid intubation thus minimize airway trauma and avoid barotrauma. The primary aim of this randomized trial was to compare the need for mechanical ventilation (MV) between the administration of surfactant via a thin catheter during spontaneous breathing and the InSurE technique. Methods: Preterm infant's ≤34 weeks with RDS requiring continuous positive airway pressure (CPAP) within 6 hours of life were prospectively randomized to receive early surfactant either by SurE (surfactant without endotracheal tube intubation) or InSurE technique. The need for MV within the first 72 hours and other related outcomes were analyzed between the two groups. Results: One hundred seventy‐five infants in each group were analyzed. The need for MV in the first 72 hours of life was significantly lower in the SurE group compared to the InSurE group (19% vs 40%, P < .01). Similarly, duration of oxygen therapy and hospital stay were significantly shorter in the SurE group. Furthermore, bronchopulmonary dysplasia (BPD) rate was significantly lower among the infants administered surfactant by the SurE technique. Conclusion: In preterm neonates with RDS who are stabilized on CPAP, the SurE technique for surfactant delivery results in the reduced need for MV and also may decrease the rate of BPD in some vulnerable subpopulations.

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“…Meanwhile, Dargaville et al 27) showed that the incidence of pneumothorax reduced from 8.0% to 2.4% after introducing…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Minimally Invasive Surfactant Therapy via Tracheal Catheterization in Neonates with a Gestational Age of 30 Weeks or More Diagnosed with Respiratory Distress Syndrome

2018

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Purpose: Minimally invasive surfactant therapy (MIST) is currently used as a method of surfactant replacement therapy (SRT) for the treatment of respiratory distress syndrome (RDS) in preterm infants with a gestational age of less than 30 weeks. However, few stud ies have been conducted on MIST in neonates with a gestational age of 30 weeks or more. In this study, we compared MIST with endotracheal intubation as a rescue SRT for spontaneously breathing neonates with a gestational age of 30 weeks or more who were diagnosed with RDS. Methods: We investigated the clinical characteristics of spontaneously breathing neo nates admitted to the neonatal intensive care unit of the Inje University Sanggye Paik Hospital from January 1, 2014 to December 31, 2016. These neonates were born at a ges tational age of 30 weeks or more and were diagnosed with RDS. The neonates who were administered surfactant by MIST were categorized into the MIST group (n=16) and those who underwent endotracheal intubation were categorized into the control group (n=45). Thereafter, the clinical characteristics between the groups were compared. Results: Compared to the control group, the MIST group was less likely to require me chanical ventilation within 72 hours (P<0.001). The frequency of bradycardia during SRT was also low in the MIST group (P=0.033). Conclusion: MIST is considered relatively feasible and safe for treating RDS for reducing the need for mechanical ventilation and decreasing the occurrence of bradycardia during surfactant administration in neonates with a gestational age of 30 weeks or more.

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Impact of Minimally Invasive Surfactant Therapy in Preterm Infants at 29-32 Weeks Gestation

Cited by 42 publications

References 24 publications

Minimally invasive surfactant therapy failure: risk factors and outcome

Minimally invasive surfactant therapy failure: risk factors and outcome

Surfactant therapy in premature babies: SurE or InSurE

Clinical Outcomes of Minimally Invasive Surfactant Therapy via Tracheal Catheterization in Neonates with a Gestational Age of 30 Weeks or More Diagnosed with Respiratory Distress Syndrome

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