Randomized Trial of Surfactant Therapy via Laryngeal Mask Airway Versus Brief Tracheal Intubation in Neonates Born Preterm

Gallup, Jacqueline A.; Ndakor, Sussan Mbi; Pezzano, Chad; Pinheiro, Joaquim

doi:10.1016/j.jpeds.2022.10.009

Cited by 22 publications

(15 citation statements)

References 42 publications

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“…Laryngeal masks can be used to administer surfactant in babies [80]. A recent study confirmed non-inferiority to IN-SUR-E in preterm babies as low as 800 g, probably related to sedation protocols for endotracheal tube placement [81].…”

Section: Introductionmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

et al. 2023

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Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of “European Guidelines for the Management of RDS” by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible. Methods of ongoing non-invasive respiratory support have been further refined and may help reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation by targeted use of postnatal corticosteroids remains essential. The general care of infants with RDS is also reviewed, including emphasis on appropriate cardiovascular support and judicious use of antibiotics as being important determinants of best outcome. We would like to dedicate this guideline to the memory of Professor Henry Halliday who died on November 12<sup>,</sup> 2022.These updated guidelines contain evidence from recent Cochrane reviews and medical literature since 2019. Strength of evidence supporting recommendations has been evaluated using the GRADE system. There are changes to some of the previous recommendations as well as some changes to the strength of evidence supporting recommendations that have not changed. This guideline has been endorsed by the European Society for Paediatric Research (ESPR) and the Union of European Neonatal and Perinatal Societies (UENPS).

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Section: Introductionmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

et al. 2023

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“…There have been several therapeutic strategies that have emerged for potential prevention of NRS failure. Less invasive surfactant administration techniques such as INSURE technique, ( 27) thin catheter surfactant administration,(28, 29) surfactant administration through laryngeal or supraglottic airways (SALSA) (30)(31)(32) and aerosolization (33)(34)(35)(36)(37) has shown favorable safety and e cacy pro les. In particular, aerosolized surfactant when widely available will be an attractive therapeutic option given its true noninvasive nature.…”

Section: Discussionmentioning

confidence: 99%

Respiratory Severity Score and Oxygen Saturation Index during the first two hours of life as predictors for non-invasive respiratory support failure in moderate preterm infants with respiratory distress syndrome

Kaluarachchi,

Zapata,

Koueik

et al. 2024

Preprint

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Background Noninvasive respiratory support (NRS) failure is common in preterm infants with respiratory distress syndrome (RDS). We evaluated the utility of Respiratory Severity Score (RSS) and Oxygen Saturation Index (OSI) during the first two hours of life (HOL) as a predictor for NRS failure.Methods We conducted a retrospective cohort study of infants born between 28 0/7 to 33 6/7 weeks with RDS. Univariate and multivariable logistic regression analysis were used to assess whether the RSS and OSI summary measures were associated with NRS failure.Results Among 282 infants included in the study 58 (21%) developed NRS failure. RSS and OSI summary measures in the first 2 HOL were associated with NRS failure within 72 HOL.Conclusion RSS and OSI during the first two HOL can predict NRS failure. Optimal RSS and OSI cutoffs for prediction of NRS failure need to be determined in large cohort studies.

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“…(11) Following this, 8 RCTs were conducted to compare the efficacy of surfactant administration through laryngeal mask or supraglottic airway (SALSA) against nCPAP without surfactant (12,13) or INSURE technique surfactant delivery (Table 1). (14)(15)(16)(17)(18)(19) The critical limitation of these trials is that they either did not report the prior sample size estimate or did not recruit enough participants to meet the calculated sample size. Six out of eight clinical trials were single-center trials which reduces the external validity of the results.…”

Section: Laryngeal Mask-assisted Surfactant Deliverymentioning

confidence: 99%

“… 11 Following this, eight RCTs were conducted to compare the efficacy of surfactant administration through laryngeal mask or supraglottic airway (SALSA) against nCPAP without surfactant 12 13 or INSURE technique surfactant delivery ( Table 1 ). 14 15 16 17 18 19 …”

Section: Laryngeal Mask-assisted Surfactant Deliverymentioning

confidence: 99%

Less Invasive Surfactant Administration: A Viewpoint

Mani

Rawat

2022

Am J Perinatol

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The standard of care in treating respiratory distress syndrome in preterm infants is respiratory support with nasal continuous positive airway pressure (nCPAP) or a combination of CPAP and exogenous surfactant replacement. Endotracheal intubation, the conventional method for surfactant administration, is an invasive procedure associated with procedural and mechanical ventilation complications. INSURE (Intubation, Surfactant administration, and Extubation soon after) technique is an accepted method aimed at reducing the short-term complications and long-term morbidities related to mechanical ventilation but does not eliminate risks associated with endotracheal intubation and mechanical ventilation. Alternative methods of surfactant delivery that can overcome the problems associated with INSURE technique are surfactant through a laryngeal mask, surfactant through a thin intratracheal catheter, and aerosolized surfactant delivered using nebulizers. The three alternative methods of surfactant delivery studied in the last two decades have advantages and limitations. More than a dozen randomized controlled trials have aimed to study the benefits of the three alternative techniques of surfactant delivery compared with INSURE as the control arm, with promising results in terms of reduction in mortality, need for mechanical ventilation, and bronchopulmonary dysplasia. The need to find a less invasive surfactant administration technique is a clinically relevant problem. Before broader adoption in routine clinical practice, the most beneficial technique among the three alternative strategies should be identified. This review aims to summarize the current evidence for using the three alternative techniques of surfactant administration in neonates, compare the three techniques, highlight the knowledge gaps and suggest future directions.

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Randomized Trial of Surfactant Therapy via Laryngeal Mask Airway Versus Brief Tracheal Intubation in Neonates Born Preterm

Cited by 22 publications

References 42 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

Respiratory Severity Score and Oxygen Saturation Index during the first two hours of life as predictors for non-invasive respiratory support failure in moderate preterm infants with respiratory distress syndrome

Less Invasive Surfactant Administration: A Viewpoint

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