Surfactant treatment and incidence of intraventricular haemorrhage in severe respiratory distress syndrome.

McCord, F B; Curstedt, Tore; Halliday, Henry L.; McClure, G; Reid, Mark; Robertson, Bengt

doi:10.1136/adc.63.1.10

Cited by 34 publications

(6 citation statements)

References 26 publications

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“…Using a natural porcine surfactant, several authors have noticed a significant decrease in MABP as soon as two minutes after surfactant administration.3 9 It is likely that a rapid decrease in pulmonary vascular resistance, as a result of lung expansion, could have promoted ductal shunting and therefore lowered blood pressure. 1 It has been reported that slow infusion of surfactant may not distribute evenly in the lung and thus is less efficient for the treatment of RDS (Segerer H, personal communication). In the present study the two proceduresrapid and slow instillationseemed to be equally effective in improving the acute clinical outcome as judged by the a/A P02 ratio in the two groups 72 hours after the first dose of surfactant.…”

Section: Discussionmentioning

confidence: 99%

Instillation rate effects of Exosurf on cerebral and cardiovascular haemodynamics in preterm neonates.

Saliba

Nashashibi

Vaillant

et al. 1994

Archives of Disease in Childhood - Fetal and Neonatal Edition

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The acute effects of surfactant instillation rate on the cerebral and cardiovascular haemodynamics were studied in a randomised trial of 27 preterm neonates with respiratory distress syndrome (RDS). Cerebral blood flow velocity (CBFV), mean arterial blood pressure (MABP), blood gases and electroencephalogram (EEG) were continuously recorded before, during, and for at least 10 minutes after the administration of surfactant. The measurements were repeated one, three, and six hours later. Left ventricular output (LVO) and ductal patency were assessed 10 minutes before and then one, three, and six hours after surfactant administration. view of this we attempted to determine in a randomised study whether the instillation rate of (Exosurf) will induce acute changes in CBFV, EEG, and cardiovascular haemodynamics including mean arterial blood pressure (MABP), left ventricular output (LVO), and patency of the ductus arteriosus. MethodsThe study was conducted on 27 consecutive newborn infants who had been admitted to the neonatal intensive care unit of the University Hospital, Tours, France. All babies entering the study had severe RDS, as judged by an a/A partial oxygen pressure (Po2) ratio of less than 0-22. The criteria for diagnosing RDS were as follows: tachypnoea (more than 60 breaths/minute), substernal and intercostal recession; grunting and clinical diagnosis supported by radiological appearances. In all babies the lecithin:sphingomyelin (L:S) ratio in the tracheal aspirate was less than 1-5, mean (SD) 1-15 (0-31). The infants were randomly assigned to receive as quickly as possible after birth a synthetic surfactant (Exosurf) either rapidly over a period of five minutes or slowly over a period of 15 minutes. All infants were receiving mechanical ventilation with a fractional inspired oxygen (Fio2) of 60% or more to maintain a transcutaneous carbon dioxide tension (TcPco2) between 5-3 and 6-6 kPa (40 and 50 mm Hg) and a transcutaneous oxygen tension (TcPo2) between 8 and 953 kPa (60 and 70 mm Hg).Surfactant studies were begun when the infants were less than 12 hours old. After endotracheal suctioning surfactant was administered via the sideport on the special endotracheal tube adaptor without interrupting mechanical ventilation. During surfactant instillation, Fio2 was increased so that the arterial oxygen saturation (Sao2) (Datex; pulse oximeter) remained within clinically accepted limits (95-97%). The newborns were not hyperventilated. In the rapid instillation group a 5 mI/kg dose of surfactant was administered by bolus injection over five minutes. Surfactant was instilled in small bursts timed with inspiration, the infant's head being in the midline. In the slow instillation group the surfactant was given manually over 15 minutes, with the babies lying supine and the head in middle position. All infants received an additional dose 12 hours later. Only the effects ofthe first dose were studied. None of the infants was sedated nor were they paralysed. Consent for the investigation was obtained from the ...

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Section: Discussionmentioning

confidence: 99%

Instillation rate effects of Exosurf on cerebral and cardiovascular haemodynamics in preterm neonates.

Saliba

Nashashibi

Vaillant

et al. 1994

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…Equipment was costed on an annual equivalent basis at 5%, in line with the rules specified at that time by the Treasury. 4 The cost of replacing equipment was converted to an annual charge, equivalent to a rental charge. The cost ofmaintenance was assessed at 10% of the cost of replacement per year.…”

Section: Methodsmentioning

confidence: 99%

Cost of surfactant replacement treatment for severe neonatal respiratory distress syndrome: a randomised controlled trial.

Tubman

Halliday

Normand

1990

BMJ

Self Cite

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“…Early complications such as pneumothorax and IVH have long been linked to the severity of RDS [21], and are explicable on this basis in infants failing CPAP. The finding of a protracted influence on lung function, with long-lasting oxygen requirements and a relatively high rate of BPD, reaffirms the value of optimising early respiratory management in preterm infants, in particular administration of surfactant to those with surfactant deficiency.…”

Section: Discussionmentioning

confidence: 99%

Continuous Positive Airway Pressure Failure in Preterm Infants: Incidence, Predictors and Consequences

et al. 2013

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Background: Preterm infants ≤32 weeks' gestation are increasingly being managed on continuous positive airway pressure (CPAP), without prior intubation and surfactant therapy. Some infants treated in this way ultimately fail on CPAP and require intubation and ventilation. Objectives: To define the incidence, predictors and consequences of CPAP failure in preterm infants managed with CPAP from the outset. Methods: Preterm infants 25-32 weeks' gestation were included in the study if inborn and managed with CPAP as the initial respiratory support, with division into two gestation ranges and grouping according to whether they were successfully managed on CPAP (CPAP-S) or failed on CPAP and required intubation <72 h (CPAP-F). Predictors of CPAP failure were sought, and outcomes compared between the groups. Results: 297 infants received CPAP, of which 65 (22%) failed, with CPAP failure being more likely at lower gestational age. Most infants failing CPAP had moderate or severe respiratory distress syndrome radiologically. In multivariate analysis, CPAP failure was found to be predicted by the highest FiO₂ in the first hours of life. CPAP-F infants had a prolonged need for respiratory support and oxygen therapy, and a higher risk of death or bronchopulmonary dysplasia at 25-28 weeks' gestation (CPAP-F 53% vs. CPAP-S 14%, relative risk 3.8, 95% CI 1.6, 9.3) and a substantially higher risk of pneumothorax at 29-32 weeks. Conclusion: CPAP failure in preterm infants usually occurs because of unremitting respiratory distress syndrome, is predicted by an FiO₂ ≥0.3 in the first hours of life, and is associated with adverse outcomes.

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Surfactant treatment and incidence of intraventricular haemorrhage in severe respiratory distress syndrome.

Cited by 34 publications

References 26 publications

Instillation rate effects of Exosurf on cerebral and cardiovascular haemodynamics in preterm neonates.

Instillation rate effects of Exosurf on cerebral and cardiovascular haemodynamics in preterm neonates.

Cost of surfactant replacement treatment for severe neonatal respiratory distress syndrome: a randomised controlled trial.

Continuous Positive Airway Pressure Failure in Preterm Infants: Incidence, Predictors and Consequences

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