Lung recruitment before surfactant administration in extremely preterm neonates with respiratory distress syndrome (IN-REC-SUR-E): a randomised, unblinded, controlled trial

Vento, Giovanni; Ventura, Maria Luisa; Pastorino, Roberta; Kaam, Anton H. van; Carnielli, Virgilio P.; Cools, Filip; Dani, Carlo; Mosca, Fabio; Polglase, Graeme R.; Tagliabue, Paolo; Boni, Luca; Cota, Francesco; Tana, Milena; Tirone, Chiara; Aurilia, Claudia; Lio, Alessandra; Costa, Simonetta; D’Andrea, Vito; Lucente, Mariella; Nigro, Gabriella; Giordano, Lucio; Roma, Vincenzina; Villani, Paolo; Fusco, Francesca Paola; Fasolato, Valeria; Colnaghi, Maria Rosa; Matassa, Piero Giuseppe; Vendettuoli, Valentina; Poggi, Chiara; Vecchio, Antonio Del; Petrillo, Flavia; Betta, Pasqua; Mattia, Carmine; Garani, Giampaolo; Solinas, Agostina; Gitto, Eloisa; Salvo, Vincenzo; Gargano, Giancarlo; Balestri, Eleonora; Sandri, Fabrizio; Mescoli, Giovanna; Martinelli, Stefano; Ilardi, Laura; Ciarmoli, Elena; Fabio, Sandra Di; Maranella, Eugenia; Grassia, Carolina; Ausanio, Gaetano; Rossi, Vincenzo; Motta, A. A.; Tina, Lucia Gabriella; Maiolo, Kim; Nobile, Stefano; Messner, Hubert; Staffler, Alex; Ferrero, Federica; Stasi, Ilaria; Pieragostini, Luisa; Mondello, Isabella; Haass, Cristina; Consigli, Chiara; Vedovato, Stefania; Grison, Alessandra; Maffei, G; Presta, G.; Perniola, Roberto; Vitaliti, Marcello; Re, Maria Paola; Curtis, Mario De; Cardilli, Viviana; Lago, Paola; Tormena, F.; Orfeo, Luigi; Gizzi, Camilla; Massenzi, Luca; Gazzolo, Diego; Strozzi, Maria Chiara; Bottino, Roberto; Pontiggia, F; Berardi, Alberto; Guidotti, Isotta; Cacace, Caterina; Meli, Valerio; Quartulli, Lorenzo; Scorrano, Antonio; Casati, Alessandra; Grappone, Lidia; Pillow, J. Jane

doi:10.1016/s2213-2600(20)30179-x

Cited by 50 publications

(43 citation statements)

References 30 publications

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“…I would like to provide the following details to help the readers understand our study and to clarify some doubts and limitations outlined in the commentary. In our study, 2 infants with sufficient respiratory drive were extubated within 30 mins after surfactant administration and recommenced on nasal CPAP. No pre‐specified respiratory parameters needed to be met in either study group, except for a sufficient respiratory drive (ie no apnoea).…”

Section: Dear Editormentioning

confidence: 97%

“…We read with great interest the EBNEO commentary by Benjamin W. Ackermann and Kirsten Glaser 1 on our study showing that a lung recruitment manoeuvre just before surfactant administration (IN‐REC‐SUR‐E) improves the efficacy of surfactant treatment in extremely preterm neonates compared with the standard IN‐SUR‐E technique, without increasing the risk of adverse neonatal outcomes 2 …”

Section: Dear Editormentioning

confidence: 99%

“…No pre‐specified respiratory parameters needed to be met in either study group, except for a sufficient respiratory drive (ie no apnoea). Regarding the re‐intubation criteria to start mechanical ventilation after IN‐REC‐SUR‐E or IN‐SUR‐E, they were poor oxygenation with FiO 2 of greater than 0·40, respiratory acidosis (pCO 2 >65 mm Hg and pH <7·20) or apnoea, despite optimal nasal CPAP, nasal intermittent positive pressure ventilation or bilevel positive airway pressure, as described in the manuscript 2 The unblinded design was a declared limitation but a pragmatic necessity of our study.…”

Section: Dear Editormentioning

confidence: 99%

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Letter to the Editor concerning the manuscript: Lung recruitment prior to IN‐SUR‐E procedure‐Safe and effective?

Vento

2021

Acta Paediatrica

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Section: Dear Editormentioning

confidence: 97%

Section: Dear Editormentioning

confidence: 99%

Section: Dear Editormentioning

confidence: 99%

See 1 more Smart Citation

Letter to the Editor concerning the manuscript: Lung recruitment prior to IN‐SUR‐E procedure‐Safe and effective?

Vento

2021

Acta Paediatrica

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“… 42 Although there was a reduced requirement for mechanical ventilation during the first 72 hours of age in the IN-REC-SUR-E (40%) group compared to the IN-SUR-E (54%) group (p=0.037), no difference was found between the two groups in the incidence of moderate to severe BPD. 43 The decreased need for mechanical ventilation is promising, but adequately powered studies are needed to determine any benefits for BPD.…”

Section: Surfactant Administrationmentioning

confidence: 99%

An Update on the Prevention and Management of Bronchopulmonary Dysplasia

Hennelly¹,

Greenberg²,

Aleem³

2021

PHMT

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Bronchopulmonary dysplasia (BPD) is a common morbidity affecting preterm infants and is associated with substantial long-term disabilities. There has been no change in the incidence of BPD over the past 20 years, despite improvements in survival and other outcomes. The preterm lung is vulnerable to injuries occurring as a result of invasive ventilation, hyperoxia, and infections that contribute to the development of BPD. Clinicians caring for infants in the neonatal intensive care unit use multiple therapies for the prevention and management of BPD. Non-invasive ventilation strategies and surfactant administration via thin catheters are treatment approaches that aim to avoid volutrauma and barotrauma to the preterm developing lung. Identifying high-risk infants to receive postnatal corticosteroids and undergo patent ductus arteriosus closure may help to individualize care and promote improved lung outcomes. In infants with established BPD, outpatient management is complex and requires coordination from several specialists and therapists. However, most current therapies used to prevent and manage BPD lack solid evidence to support their effectiveness. Further research is needed with appropriately defined outcomes to develop effective therapies and impact the incidence of BPD.

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“…The benefits of lung recruitment have been demonstrated in animal studies, especially before surfactant administration. A recent RCT showed that a lung recruitment maneuver just before surfactant administration improved the efficacy of surfactant treatment in extremely preterm neonates compared with standard INSURE technique [28]. Although there was a reduced need for mechanical ventilation during the first 72 h after treatment, some neonatologists have raised concerns about adopting this procedure in routine neonatal practice.…”

mentioning

confidence: 99%

Sharing Progress in Neonatology (SPIN): Oxygen and Surfactant, Optimal Ventilation, Pulmonary Hypertension, Diagnostic Procedures, and Definition of Bronchopulmonary Dysplasia

Halliday¹,

Speer²

2021

Neonatology

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Lung recruitment before surfactant administration in extremely preterm neonates with respiratory distress syndrome (IN-REC-SUR-E): a randomised, unblinded, controlled trial

Cited by 50 publications

References 30 publications

Letter to the Editor concerning the manuscript: Lung recruitment prior to IN‐SUR‐E procedure‐Safe and effective?

Letter to the Editor concerning the manuscript: Lung recruitment prior to IN‐SUR‐E procedure‐Safe and effective?

An Update on the Prevention and Management of Bronchopulmonary Dysplasia

Sharing Progress in Neonatology (SPIN): Oxygen and Surfactant, Optimal Ventilation, Pulmonary Hypertension, Diagnostic Procedures, and Definition of Bronchopulmonary Dysplasia

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