More about Surfactant, Oxygen, Caffeine and Chronic Lung Disease

Pharmacologic interventions for the prevention and treatment of retinopathy of prematurity

“…Caffeine has been used in combination with non-steroidal anti-inflammatory drugs (NSAIDs) for many decades to enhance their analgesic effects, suggesting that caffeine may be an effective adjuvant to NSAIDs (122)(123)(124). Due to its significant impact on major acute neonatal morbidities including AOP, BPD, PDA, and ROP, caffeine is now recognized as the "wonder drug in neonatology" (125) and the "silver bullet in neonatology" (126). Notwithstanding, only one prospective randomized, controlled multicenter clinical trials to investigate the benefits of caffeine for prevention of ROP has been initiated (Aranda JV, Clinicaltrials.gov Identifier: NCT02344225).…”

Retreatment With Surfactant in Very Low Birth Weight Preterm Infants: Risk Predictors and Their Influence on Neonatal Outcomes

“…Other authors demonstrated a decrease in BPD frequency with the administration of higher doses, different surfactant types (porcine surfactant), and early administration to surfactant replacement. 7,8,13,19,[21][22][23] Moreover, in other studies in the literature, using wider FiO 2 for indicating surfactant retreatment, such as the use of FiO 2 <0.3 and early rescue, multiple doses of surfactant were not associated to adverse outcomes. 7,8,13,19,[21][22][23] Therefore, we considered that the value of FiO 2 >0.4 for indicating the retreatment of patients under 26 weeks might have favored the association with bronchopulmonary dysplasia.…”

“…7,8,13,19,[21][22][23] Moreover, in other studies in the literature, using wider FiO 2 for indicating surfactant retreatment, such as the use of FiO 2 <0.3 and early rescue, multiple doses of surfactant were not associated to adverse outcomes. 7,8,13,19,[21][22][23] Therefore, we considered that the value of FiO 2 >0.4 for indicating the retreatment of patients under 26 weeks might have favored the association with bronchopulmonary dysplasia. Lim et al demonstrated that the use of surfactant with FiO 2 >0.3 in 25-28 weeks gestational age neonates is related to worse outcomes (bronchopulmonary dysplasia, death, necrotizing enterocolitis, and other morbidities) and the more recent European consensus guideline on the management of respiratory distress syndrome suggests surfactant administration when FiO 2 >0.3 is needed in all gestational ages.…”

Pharmacologic interventions for the prevention and treatment of retinopathy of prematurity

“…Caffeine has been used in combination with non-steroidal anti-inflammatory drugs (NSAIDs) for many decades to enhance their analgesic effects, suggesting that caffeine may be an effective adjuvant to NSAIDs (122–124). Due to its significant impact on major acute neonatal morbidities including AOP, BPD, PDA, and ROP, caffeine is now recognized as the “wonder drug in neonatology” (125) and the “silver bullet in neonatology” (126). Notwithstanding, only one prospective randomized, controlled multicenter clinical trials to investigate the benefits of caffeine for prevention of ROP has been initiated (Aranda JV, Clinicaltrials.gov Identifier: NCT02344225).…”