Surfactant administration via a thin endotracheal catheter during spontaneous breathing in preterm infants

Wu, Wanliang; Shi, Yan; Li, Fengxia; Wen, Zhuoyu; Liu, Hongli

doi:10.1002/ppul.23651

Cited by 10 publications

(4 citation statements)

References 32 publications

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“…Additionally, a large cohort study found LISA to be associated with a significant reduction in invasive ventilation (12% versus 18%, P = 0.001), reduced postnatal steroid use (2.5% versus 7%, P < 0.001), BPD (12% versus 18%, P = 0.001) and BPD or death (14% versus 21%, P < 0.001) 40 . Furthermore, Wu et al analyzed the results from selected trials using LISA and validated the beneficial aspects of the thin-catheter strategy in terms of decreased requirement of MV and, consequently, a reduction in BPD incidence 41 .…”

Section: Discussionmentioning

confidence: 99%

A clinical study evaluating the combination of LISA and SNIPPV for the treatment of respiratory distress syndrome in preterm infants

Permall,

Zhang,

et al. 2024

Sci Rep

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To compare the therapeutic effect of less invasive surfactant administration (LISA) followed by synchronized nasal intermittent positive pressure ventilation (SNIPPV) and traditional intubate-Surfactant-Extubate (InSurE) strategy for the treatment of neonatal respiratory distress syndrome (NRDS). A single-center, non-randomized and single- blinded study Tertiary neonatal intensive care unit 89 infants enrolled were preterm with gestational age < 366/7 weeks and clinically diagnosed with neonatal RDS (NRDS) Interventions: 32 infants were assigned to the LISA + SNIPPV group and 57 infants to the InSurE + nCPAP group. No statistically significant differences were noted in the baseline characteristics of the enrolled infants. A lower proportion of infants developed BPD in the LISA + SNIPPV group compared to the InSurE + CPAP group [10 (31.25%) vs. 21 (36.84%), P > 0.05]; however, there was no statistically significant difference. The number needed to treat (NNT) with LISA + SNIPPV to prevent BPD development is 18. The mortality rate was not significant between our study arms [1 (3.13%) vs 2 (3.51%), P > 0.05]. There were no statistically significant differences in the durations (days) of MV [(12.18 ± 13.89) vs. (11.35 ± 11.61), P > 0.05], oxygen therapy [(35.03 ± 19.13) vs. (39.75 ± 17.91), P > 0.05] and re-intubation rates [(0.19 ± 0.40) vs. (0.21 ± 0.45), P > 0.05] between the two study groups. In terms of complications, the incidence of patent ductus arteriosus (PDA) [24 (75.00%) vs. 27 (47.37%), P < 0.05] was higher and a lower rate of disturbed liver function [1 (3.23%) vs. 19 (33.33%), P < 0.05] were observed in the LISA + SNIPPV group. Acid–base imbalances were reportedly significantly higher in the InSurE group (P < 0.05). No significant differences in other complications were noted. In the interventional group, FiO2 requirements were significantly lower up until the 3rd week of treatment [FiO2 at day 0, (30.75 ± 4.78) vs. (34.66 ± 9.83), P < 0.05; FiO2 at day 21, (25.32 ± 3.74) vs. (29.11 ± 8.17), P < 0.05], as was RSS on days 2 [(0.77 ± 0.38) vs. (1.94 ± 0.75), P < 0.05] and 3 [(0.66 ± 0.33) vs. (1.89 ± 0.82), P < 0.05] after treatment. Additionally, infants in the standard group had a significantly prolonged hospital stay (days) [(45.97 ± 16.93) vs. (54.40 ± 16.26), P < 0.05]. The combination of LISA and SNIPPV for NRDS can potentially lower the rate of BPD, FiO2 demand and shorten the length of hospitalization.

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Section: Discussionmentioning

confidence: 99%

A clinical study evaluating the combination of LISA and SNIPPV for the treatment of respiratory distress syndrome in preterm infants

Permall,

Zhang,

et al. 2024

Sci Rep

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“…Low-dose sedation was associated with an increased comfort score, but the need for transient non-invasive ventilation was increased [ 42 ]. A catheter inserted too deep can result in unilateral surfactant deposition leading to pneumothorax and PIE secondary to unilateral lung hyperinflation, but this has not been seen as a major problem in studies to date [ 43 ]. There are other possible adverse effects of LISA.…”

Section: Insurementioning

confidence: 99%

Evaluation of methods of surfactant administration in the delivery suite?

2021

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Surfactant administered in the delivery suite might prevent or reduce the severity of subsequent respiratory distress syndrome. This review describes the evidence for surfactant delivery methods with relationship to their relevance in the delivery suite. The techniques include delivery using a thin catheter with the first breath, by the intubation-surfactant extubation procedure, less invasive surfactant administration (LISA) technique, using a laryngeal mask airway (LMA), or by nebulisation. There have been few randomised trials that have evaluated outcomes using these techniques in the delivery suite, and these were early trials. Currently, practitioners favour use of nasal continuous positive airway pressure with early rescue surfactant. Whether prophylactic surfactant given by the LISA technique or other techniques, such as via a LMA in the delivery suite, is more beneficial merits testing. This will require appropriately designed randomised trials with long-term outcomes.

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“…It would not make much sense to combine studies that have different comparators in a meta-analysis. A recently published systematic review by Wu et al addresses the outcomes of surfactant administration in a minimally invasive way (via thin endotracheal catheter) to spontaneously breathing infants (14). In this review, four studies are included for the outcome of requiring mechanical ventilation within the first 72 h of life (15)(16)(17)(18).…”

Section: Heterogeneity In Included Populations Interventions Contromentioning

confidence: 99%

Systematic Reviews in Neonatal Respiratory Care: Are Some Conclusions Misleading?

Maturana

Moya²,

Donn

2020

Front. Pediatr.

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An increasing amount of information is currently available in neonatal respiratory care. Systematic reviews are an important tool for clinical decision-making. The challenge is to combine studies that address a specific clinical question and have similar characteristics in terms of populations, interventions, comparators, and outcomes, so that their combined results provide a more precise estimate of the effect that can be validly extrapolated into clinical practice. The concept of heterogeneity is reviewed, emphasizing that it should be considered in a wider perspective and not just as a mere statistical test. A case is made of how well-designed studies of the neonatal respiratory literature, when equivocally combined, can provide very precise but potentially biased results. Systematic reviews in this field and others should be rigorously peer-reviewed before publication to avoid misleading readers to potentially biased conclusions.

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Surfactant administration via a thin endotracheal catheter during spontaneous breathing in preterm infants

Cited by 10 publications

References 32 publications

A clinical study evaluating the combination of LISA and SNIPPV for the treatment of respiratory distress syndrome in preterm infants

A clinical study evaluating the combination of LISA and SNIPPV for the treatment of respiratory distress syndrome in preterm infants

Evaluation of methods of surfactant administration in the delivery suite?

Systematic Reviews in Neonatal Respiratory Care: Are Some Conclusions Misleading?

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