Surfactant administration without intubation in preterm infants with respiratory distress syndrome – our experiences

Krajewski, Paweł; Chudzik, Anita; Strzałko-Głoskowska, Barbara; Górska, Monika; Kmiecik, Magdalena; Więckowska, Katarzyna; Mesjasz, Anna; Sieroszewski, Piotr

doi:10.3109/14767058.2014.947571

Cited by 24 publications

(20 citation statements)

References 23 publications

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“…30 In contrast, Krajewski et al conducted a cohort study involving 26 preterm infants with RDS receiving surfactant via thin catheter and reported significant reductions in the need for mechanical ventilation (19.2% vs 65%, P < .05) and BPD (15.4% vs 40%, P < .05) compared to historical results with the INSURE technique. 31 …”

Section: Discussionmentioning

confidence: 99%

Less Invasive Surfactant Administration Reduces the Need for Mechanical Ventilation in Preterm Infants

Lau

Chamberlain

Sun

2017

Global Pediatric Health

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Neonatal respiratory distress syndrome due to surfactant deficiency is associated with high morbidity and mortality in preterm infants, and the use of less invasive surfactant administration (LISA) has been increasingly studied. This meta-analysis found that LISA via thin catheter significantly reduced the need for mechanical ventilation within the first 72 hours (relative risk [RR] = 0.677; P = .021), duration of mechanical ventilation (difference in means [MD] = −39.302 hours; P < .001), duration of supplemental oxygen (MD = −68.874 hours; P < .001), and duration of nasal continuous positive airway pressure (nCPAP; MD = −28.423 hours; P = .010). A trend toward a reduction in the incidence of bronchopulmonary dysplasia was observed (RR = 0.656; P = .141). No significant difference in overall mortality, incidence of pneumothorax, or successful first attempts was observed. LISA via thin catheter significantly reduces the need for mechanical ventilation within the first 72 hours as well as the duration of mechanical ventilation, supplemental oxygen, and nCPAP. LISA via thin catheter appears promising in improving preterm infant outcomes.

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Section: Discussionmentioning

confidence: 99%

Less Invasive Surfactant Administration Reduces the Need for Mechanical Ventilation in Preterm Infants

Lau

Chamberlain

Sun

2017

Global Pediatric Health

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“…Mothers had a mean age of 31.0 (16-40) years and only one of them presented an underlying medical condition (HELLP syndrome). The more frequent type of delivery was C-section (15/20, 75.0%), and the multiple birth rate was 35.0% (7/20). Only three preterm infants (15.0%) were hospitalized on the rst day of admission at the NICU, whereas the rest of neonates (17/20, 85.0%) were admitted to an intermediate neonatal care unit.…”

Section: Resultsmentioning

confidence: 99%

“…A meta-analysis conducted by Lau et al [32] provides a comprehensive review of the use of LISA via thin catheter in preterm infants, examining the results of several studies [14,[33][34][35]. Overall, the authors underline the suitability of this technique in preterm infants.…”

Section: Discussionmentioning

confidence: 99%

Less Invasive Surfactant Administration via Thin Catheter in Late Preterm Infants With Respiratory Distress Syndrome

Arenas

Guiard

García

et al. 2020

Preprint

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Background: The use of less invasive surfactant administration (LISA) has been increasingly investigated, since neonatal respiratory distress syndrome (RDS) due to surfactant deficiency is associated with high morbidity and mortality in preterm infants. However, this technique has been barely studied in late preterm newborns with RDS. In the present study, we analyzed the use of LISA using a thin catheter in late preterm infants with RDS who required noninvasive ventilation (NIV).Methods: A retrospective study was conducted on late preterm infants admitted to the Neonatal Intensive Care Unit – Virgen de la Arrixaca University Hospital in Murcia (Spain), between June 2017 and March 2020. Maternal and prenatal data, as well as safety and efficacy variables related to the technique were collected. Statistical analyses were performed using SPSS version 20.0.Results: A total of 20 patients were included. The mean gestational age was 35 (341/7-366/7) weeks. There were 12 males (60.0%) and 8 females (40.0%). Seven infants (35.0%) received prenatal corticosteroids for fetal lung maturation. Mothers had a mean age of 31.0 (16-40) years and only one had a medical condition (HELLP syndrome). The more frequent type of delivery was C-section (75.0%). Ten newborns (50.0%) required resuscitation to breathe with nCPAP or nIPPV, with no signs of acute fetal distress. Before LISA, mean pCO2, pH and FiO2 values were 53 (40-81) mmHg, 7.28 (7.19-7.48), and 0.41 (0.3-0.6), respectively. Thirteen patients (65.0%) were treated with nCPAP and seven (35.0%) with nIPPV. Premedications administered were caffeine (50.0%) and ketamine/morphine sedation (20.0%). During LISA, oxygen saturation decreased in fifteen patients (75.0%). Redosing was needed in two infants (10.0%). Response was favorable, with a rapid and sustained reduction in FiO2 (FiO2 of 0.21 in 85.0% of cases) and NIV mean time of 70 hours. Patients with final diagnosis of RDS (90.0%) did not required invasive mechanical ventilation (IMV). No severe comorbidities and no deaths occurred.Conclusions: LISA procedure was a safe and effective method of surfactant delivery in late premature neonates with RDS, improving respiratory outcomes with no need for IMV. These findings add to the knowledge of respiratory management of late preterm infants.

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“…They found significantly higher survival rates (75.8 vs. 64.1%), less IVH (28.1 vs. 45.9%), severe IVH (13.1 vs. 23.9%), and cystic periventricular leukomalacia (1.2 vs. 5.6%) in the infants treated with LISA method compared to their historical controls of invasive surfactant delivery. In a similar study, Krajewski et al (68) found that surfactant replacement therapy without intubation while receiving NCPAP in preterm infants was associated with significantly lower need for intubation and mechanical ventilation compared to the INSURE method (19.2 vs. 65%). In addition, better pulmonary outcomes were seen with the new method of surfactant replacement.…”

Section: Reviewmentioning

confidence: 91%

Evolution of surfactant therapy for respiratory distress syndrome: past, present, and future

et al. 2016

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Respiratory distress syndrome (RDS) due to surfactant deficiency is the most common cause of respiratory failure in preterm infants. Tremendous progress has been made since the original description that surfactant deficiency is the major cause of RDS. Surfactant therapy has been extensively studied in preterm infants and has been shown to significantly decrease air leaks and neonatal and infant mortality. Synthetic and animal-derived surfactants from bovine as well as porcine origin have been evaluated in randomized controlled trials. Animal-derived surfactants generally result in faster weaning of respiratory support, shorter duration of invasive ventilation, and decreased mortality when compared to first- or second-generation of synthetic surfactants, but some of the second-generation synthetic surfactants are at least not inferior to the animal-derived surfactants. Using a higher initial dose of porcine derived surfactant may provide better outcomes when compared with using lower doses of bovine surfactants, likely, due to compositional difference and/or the dose. Third-generation synthetic surfactant containing peptide analogs of surfactant protein B and C are currently being studied. Less invasive intra-tracheal surfactant administration techniques in spontaneously breathing neonate receiving noninvasive ventilator support are also being evaluated. In the present era, prophylactic surfactant is not recommended as it may increase the risk of lung injury or death. In the future, surfactants may be used as vector to deliver steroids, or used in combination with molecules, such as, recombinant Club Cell Protein-10 (rhCC-10) to improve pulmonary outcomes. Also, noninvasive surfactant administration techniques, such as aerosolization or atomization of surfactant may play a greater role in the future.

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Surfactant administration without intubation in preterm infants with respiratory distress syndrome – our experiences

Cited by 24 publications

References 23 publications

Less Invasive Surfactant Administration Reduces the Need for Mechanical Ventilation in Preterm Infants

Less Invasive Surfactant Administration Reduces the Need for Mechanical Ventilation in Preterm Infants

Less Invasive Surfactant Administration via Thin Catheter in Late Preterm Infants With Respiratory Distress Syndrome

Evolution of surfactant therapy for respiratory distress syndrome: past, present, and future

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Surfactant administration without intubation in preterm infants with respiratory distress syndrome – our experiences

Cited by 24 publications

References 23 publications

Less Invasive Surfactant Administration Reduces the Need for Mechanical Ventilation in Preterm Infants

Less Invasive Surfactant Administration Reduces the Need for Mechanical Ventilation in Preterm Infants

Less&nbsp;Invasive&nbsp;Surfactant&nbsp;Administration&nbsp;via&nbsp;Thin&nbsp;Catheter&nbsp;in&nbsp;Late&nbsp;Preterm&nbsp;Infants&nbsp;With&nbsp;Respiratory&nbsp;Distress&nbsp;Syndrome

Evolution of surfactant therapy for respiratory distress syndrome: past, present, and future

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Less Invasive Surfactant Administration via Thin Catheter in Late Preterm Infants With Respiratory Distress Syndrome