Less invasive surfactant administration methods: Who, what and how

Guthrie, S. O.; Roberts, K. D.

doi:10.1038/s41372-023-01778-2

Cited by 3 publications

(1 citation statement)

References 61 publications

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“…A recent umbrella review reported that the risk of BPD or mortality at 36 weeks PMA decreases with the following interventions: initiation of continuous positive airway pressure (CPAP) in the delivery room (compared with intubation), early selective surfactant (compared with late), early inhaled corticosteroids and systemic hydrocortisone, use of less invasive surfactant administration (LISA) avoiding intubation (LISA), and volume-targeted (compared with pressure-targeted) ventilation. 11,12 There continues to be concern and uncertainty about the optimal dosage, timing and risks of systemic steroids highlighting a need for additional high-quality clinical trials. 13 Furthermore, early inhaled budesonide was associated with increased mortality in neonates <28 weeks GA. 14 In comparison, intratracheal budesonide instilled with surfactant may decrease the risk of BPD without evidence of impaired neurodevelopment at 2−3 years, however larger studies are in progress.…”

Section: Preventative Measuresmentioning

confidence: 99%

ATS core curriculum 2023. Pediatric pulmonary medicine: Respiratory disorders in infants

Leon‐Astudillo,

Dy,

McCown

et al. 2024

Pediatric Pulmonology

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The American Thoracic Society Core Curriculum updates clinicians annually in pediatric pulmonary disease. This is a summary of the Pediatric Pulmonary Medicine Core Curriculum presented at the 2023 American Thoracic Society International Conference. The respiratory disorders of infancy discussed in this year's review include: the care of the patient with bronchopulmonary dysplasia in the neonatal intensive care unit, clinical phenotypes and comorbidities; diffuse lung disease; pulmonary hypertension; central and obstructive sleep apnea. The care of infants with respiratory disorders often poses significant challenges to the general pediatric pulmonologist, sleep clinician, and neonatologist. This review aims to highlight the most clinically relevant aspects of the evaluation, management, and outcomes of infants with these key respiratory disorders, while emphasizing the importance of multidisciplinary care. Furthermore, this document summarizes essential aspects of genetic testing, novel imaging and treatment modalities, and includes multiple resources for clinical practice.

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Section: Preventative Measuresmentioning

confidence: 99%

ATS core curriculum 2023. Pediatric pulmonary medicine: Respiratory disorders in infants

Leon‐Astudillo,

Dy,

McCown

et al. 2024

Pediatric Pulmonology

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Less Invasive Surfactant Administration for Preterm Infants – State of the Art

Härtel,

Kribs,

Göpel

et al. 2024

Neonatology

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Background: Less invasive surfactant administration (LISA) has become the preferred method of surfactant administration for spontaneously breathing babies on continuous positive airway pressure (CPAP). Summary: The development of LISA followed the need to combine CPAP and surfactant replacement as mainstay treatment options for respiratory distress syndrome, thereby avoided exposure to positive pressure ventilation. Key Messages: This review summarises the current knowns and unknowns of LISA including the physiological concept, its relevance for short-term and long-term outcomes and the challenges for practical implementation of LISA as part of a less invasive respiratory care bundle. Further, we provide an update of the evidence on alternatives to LISA, for example, nebulised surfactant administration, pharyngeal deposition of surfactant and delivery via supraglottic airway.

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Feasibility and safety of surfactant administration via laryngeal mask airway as first-line therapy for a select newborn population: results of a standardized clinical protocol

Kubicka,

Zahr,

Feldman

et al. 2024

Preprint

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Objectives (1) To demonstrate feasibility and safety of surfactant administration via laryngeal mask airway (LMA) as a first-line therapy. (2) To measure treatment success, defined as avoidance of intubation/invasive mechanical ventilation, and determine if specific clinical variables could predict success/failure. Study design: Observational cohort with eligible infants given surfactant using one type of LMA via standardized protocol. Data was captured prospectively followed by retrospective chart review. Results 150 infants ≥ 1250g and 28.3–41.1 weeks gestation were included. First-line LMA surfactant therapy was successful in 70% of the infants and those infants weaned to room air significantly quicker than infants requiring subsequent intubation/mechanical ventilation (p = 0.01 by 72h, p = 0.003 by 96h). Clinical variables assessed could not predict treatment success/failure. Complications were infrequent and did not differ between groups. Conclusion First-line LMA surfactant is feasible and safe for certain infants. Prediction of treatment success was not possible in our cohort.

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Less invasive surfactant administration methods: Who, what and how

Cited by 3 publications

References 61 publications

ATS core curriculum 2023. Pediatric pulmonary medicine: Respiratory disorders in infants

ATS core curriculum 2023. Pediatric pulmonary medicine: Respiratory disorders in infants

Less Invasive Surfactant Administration for Preterm Infants – State of the Art

Feasibility and safety of surfactant administration via laryngeal mask airway as first-line therapy for a select newborn population: results of a standardized clinical protocol

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