Mortality, Severe Respiratory Distress Syndrome, and Chronic Lung Disease of the Newborn Are Reduced More After Prophylactic Than After Therapeutic Administration of the Surfactant Curosurf

Egberts, J.; Brand, Roland; Walti, Hervé; Bevilacqua, G.; Breart, Gérard; F, Gardini

doi:10.1542/peds.100.1.e4

Cited by 65 publications

(33 citation statements)

References 19 publications

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“…31 The mortality of mechanically ventilated infants Ͻ30 weeks' gestation given rescue treatment with natural modified surfactant ranged from 17% to 25%. 3,4,28 The mortality was 12% to 15% in prophylactically treated infants. …”

Section: Discussionmentioning

confidence: 99%

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Nasal Continuous Positive Airway Pressure and Early Surfactant Therapy for Respiratory Distress Syndrome in Newborns of Less Than 30 Weeks' Gestation

Albertsen²,

et al. 1999

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ABSTRACT. Objective. To determine whether early versus late treatment with porcine surfactant (Curosurf) reduces the requirement of mechanical ventilation in very preterm infants primarily supported by nasal continuous positive airway pressure (nasal CPAP).Design. Multicenter randomized, controlled trial.Patients. The study population comprised 60 infants <30 weeks' gestation with respiratory distress syndrome (RDS) who had an arterial to alveolar oxygen tension ratio (a/APO 2 ) of 0.35 to 0.22.The cohort from which the study population was generated comprised 397 infants.Results. The need for mechanical ventilation or death within 7 days of age was reduced from 63% in the latetreated infants to 21% in early-treated infants. Increasing numbers of antenatal steroid doses also improved the outcome, especially in the early-treated infants. Six hours after randomization mean a/APO 2 rose to 0.48 in the earlytreated infants compared with 0.36 in the late-treated. The need of mechanical ventilation before discharge was reduced from 68% in the late-treated to 25% in the earlytreated infants.Conclusions. Nasal CPAP in combination with early treatment with Curosurf significantly improves oxygenation and reduces the subsequent need for mechanical ventilation in infants <30 weeks' gestational age with RDS. Pediatrics 1999;103(2). URL: http://www.pediatrics. org/cgi/content/full/103/2/e24; respiratory distress syndrome, pulmonary surfactant, Curosurf, nasal continuous positive airway pressure.ABBREVIATIONS. RDS, respiratory distress syndrome; nasal CPAP, nasal continuous positive airway pressure; a/APo 2 , arterial to alveolar oxygen tension ratio; Fio 2 , fraction of inspired oxygen; TcPo 2 , transcutaneous partial pressure of oxygen; TcPco 2 , transcutaneous partial pressure of carbon dioxide; PDA, patent ductus arteriosus; NEC, necrotizing enterocolitis; BPD, bronchopulmonary dysplasia; IVH, intraventricular hemorrhage; PVL, periventricular leucomalacia; ROP, retinopathy of prematurity. I n a randomized, controlled study we have shown that a single dose of surfactant (Curosurf, Chiesi Farmateutici, Parma, Italy) given by short-lasting intubation reduces the need for mechanical ventilation and improves oxygenation in infants with moderate to severe respiratory distress syndrome (RDS) treated with early nasal continuous positive airway pressure (nasal CPAP).1 Very few pulmonary and extrapulmonary complications were observed in these infants. However, some of the surfactanttreated infants supported by nasal CPAP developed apnea despite good oxygenation and needed mechanical ventilation for that reason. In the same trial, there seemed to be a higher need for ventilation among infants randomized relatively late after birth and in infants with relatively low birth weight. From the literature we know that surfactant given prophylactically, 2-4 or as early treatment to infants requiring mechanical ventilation, 5 is more effective than late rescue treatment.The present study was designed to test the hypothesis that infants Ͻ30 we...

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Section: Discussionmentioning

confidence: 99%

“…In the same trial, there seemed to be a higher need for ventilation among infants randomized relatively late after birth and in infants with relatively low birth weight. From the literature we know that surfactant given prophylactically, [2][3][4] or as early treatment to infants requiring mechanical ventilation, 5 is more effective than late rescue treatment.…”

mentioning

confidence: 99%

Nasal Continuous Positive Airway Pressure and Early Surfactant Therapy for Respiratory Distress Syndrome in Newborns of Less Than 30 Weeks' Gestation

Albertsen²,

et al. 1999

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“…A meta-analysis of these prophylaxis versus rescue treatment trials was published by Egberts et al 60 in 1997. Prophylaxis was defined as administration of surfactant in the delivery suite within 10 to 15 min of birth.…”

Section: Developing a Protocol For Surfactant Treatmentmentioning

confidence: 99%

Surfactants: past, present and future

2008

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In 1929 Kurt von Neergaard performed experiments suggesting the presence of pulmonary surfactant and its relevance to the newborn's first breath. Almost 25 years later, Richard Pattle, John Clements and Chris Macklin, each working on the effects of nerve gases on the lungs, contributed to the understanding of the physiology of pulmonary surfactant. About 5 years later Mary Ellen Avery and Jere Mead published convincing evidence that preterm neonates dying of hyaline membrane disease (respiratory distress syndrome, RDS) had a deficiency of pulmonary surfactant. The first trials of nebulized synthetic (protein-free) surfactant to prevent RDS were published soon after Patrick Bouvier Kennedy (son of President John F Kennedy) died of this disorder after treatment in Boston. These trials were unsuccessful; however, Goran Enhorning and Bengt Robertson in the early 1970s demonstrated that natural surfactants (containing proteins) were effective in an immature rabbit model of RDS. Soon after this Forrest Adams showed that a natural surfactant was also effective in an immature lamb model. Working with him was Tetsuro Fujiwara who 2 years later, after returning to Japan, published the seminal article reporting the responses of 10 preterm infants with RDS to a bolus of modified bovine surfactant. During the 1980s there were numerous randomized controlled trials of many different natural and synthetic surfactants, demonstrating reductions in pulmonary air leaks and neonatal mortality. Subsequently natural surfactants were shown to be superior to the protein-free synthetic products. Recently there have been a number of randomized trials comparing different natural surfactant preparations. Commercially available bovine surfactants may have similar efficacy but there is some evidence that a porcine surfactant used to treat RDS with an initial dose of 200 mg kg À1 is more effective than a bovine surfactant used in an initial dose of 100 mg kg -1 . Bovine and porcine surfactants have not been compared in trials of prophylaxis. Very recently a new synthetic surfactant with a surfactant protein mimic has been compared with other commercially available natural and synthetic surfactants in two trials. The new surfactant may be superior to one of the older protein-free synthetic surfactants but there is no evidence of its superiority over established natural products and it is currently not approved for clinical use. A number of other new synthetic surfactants have been tested in animal models or in treatment of adults with ARDS, but so far there have been no reports of treatment of neonatal RDS. Natural surfactants work best if given by a rapid bolus into the lungs but less invasive methods such as a laryngeal mask, pharyngeal deposition or rapid extubation to CPAP have showed promise. Unfortunately, delivery of surfactant by nebulization has so far been ineffective. Surfactant treatment has been tried in a number of other neonatal respiratory disorders but only infants with meconium aspiration seem to benefit although larger and mo...

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“…28 d Effect has only been described for one natural surfactant. 22 As the pathogenesis of disturbed alveolarization, vascularization and tissue repair in the immature lung leading to BPD is multifactorial, it is unlikely that one single agent will be identified as a 'miracle drug' in the prevention or treatment of the disease. The 'miracle drug' of the 1990s, dexamethasone, has almost completely lost its role in the management of extremely premature infants.…”

Section: Corticosteroidsmentioning

confidence: 99%

“…21 However, a meta-analysis of three trials enrolling a total of 671 preterm infants treated prophylactically with the natural porcine surfactant preparation poractant-alpha (Curosurf s ; Dey L.P. Napa CA, Chiesi Farmaceutici, S.p.A., Italy) clearly demonstrated a reduction in the severity of respiratory distress syndrome, mortality and the incidence of BPD at 28 days of life. 22 Despite the limitations of this analysis, owing to the relatively small sample size, prophylactic or early surfactant treatment may have a potential role in preventing BPD, especially in preterm infants less than 28 weeks of gestational age.…”

mentioning

confidence: 97%

Prevention and treatment of bronchopulmonary dysplasia: current status and future prospects

Thomas

Speer

2007

J Perinatol

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This review summarizes the existing evidence for potential non-ventilatordependent strategies to prevent or ameliorate bronchopulmonary dysplasia (BPD). Oxygen plays an important pathogenetic and therapeutic role for BPD. Targeting infants with lower saturation of peripheral oxygen levels than traditionally used seems justified. Inhaled nitric oxide has not proven effective on pulmonary outcome in extremely low birth weight infants. Diuretics can ameliorate lung function transiently. High intramuscular doses of vitamin A reduce the risk of BPD. Prophylactic application of natural surfactant may also confer benefits. Recently, early administration of caffeine has been shown to decrease risk of BPD. However, assessment of long-term effects is needed before routine use can be recommended. Owing to potential short-and long-term effects, postnatal corticosteroids should be restricted to the most severe manifestations of BPD. Superoxide dismutase and a1-proteinase inhibitor have not shown efficacy in preventing BPD. The potential role of anti-inflammatory therapies like Clara Cell 10 kDa protein has yet to be defined.

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Mortality, Severe Respiratory Distress Syndrome, and Chronic Lung Disease of the Newborn Are Reduced More After Prophylactic Than After Therapeutic Administration of the Surfactant Curosurf

Cited by 65 publications

References 19 publications

Nasal Continuous Positive Airway Pressure and Early Surfactant Therapy for Respiratory Distress Syndrome in Newborns of Less Than 30 Weeks' Gestation

Nasal Continuous Positive Airway Pressure and Early Surfactant Therapy for Respiratory Distress Syndrome in Newborns of Less Than 30 Weeks' Gestation

Surfactants: past, present and future

Prevention and treatment of bronchopulmonary dysplasia: current status and future prospects

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