The Role of Surfactant Therapy in Nonrespiratory Distress Syndrome Conditions in Neonates

Keiser, Amaris; Bhandari, Vineet

doi:10.1055/s-0035-1556883

Cited by 11 publications

(6 citation statements)

References 40 publications

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“…3 We also previously reported that the slowest extrauterine growth was during the transition phase, which predicted growth failure at discharge and was related to inadequate energy and protein intakes during this phase. 4 To address this vulnerable period and promote continued growth, we established a nutrient-based transition protocol that resulted in significantly improved energy and protein intakes during the transition phase.…”

Section: Discussionmentioning

confidence: 80%

Transitioning Preterm Infants From Parenteral Nutrition: A Comparison of 2 Protocols

Miller

Donda

Bhutada

et al. 2016

J Parenter Enteral Nutr

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Background Growth in preterm infants is compromised during the transition phase of nutrition, when parenteral nutrition (PN) volumes are weaned with advancing enteral nutrition (EN) feeds, likely due to suboptimal nutrient intakes during this time. We implemented new PN guidelines designed to maintain optimal nutrient intakes during the transition phase and compared growth outcomes of this cohort with a control group. Materials and Methods A chart review was conducted on infants born <32 weeks’ gestation, before (control group) and after (study group) a new transition PN protocol was implemented in the neonatal intensive care unit. Weight parameters and nutrient intakes were calculated for the transition phase and compared between the 2 groups. Results Demographic and clinical characteristics of the 2 groups were comparable except for higher rates of sepsis in control group. Weight-for-age z scores at birth, at 1 week of life, and at the start of the transition phase were similar. At the end of the transition phase, infants in the study group had significantly higher z scores compared with the control group, even when corrected for sepsis, a difference that persisted at 35 weeks’ gestation. During the transition phase, study infants gained 16.1 ± 4.6 g/kg/d compared with 13.2 ± 5.4 g/kg/d in control group (P < .001). Similar results were observed in the subset of expressed breastmilk–only fed infants (15.9 ± 4.6 g/kg/d in the study group compared with 13.2 ± 5.4 g/kg/d in the control group, P < .004). Conclusion Optimizing nutrition by the use of concentrated PN during the transition phase to maintain appropriate nutrient intakes improves growth rates in preterm infants.

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Section: Discussionmentioning

confidence: 80%

Transitioning Preterm Infants From Parenteral Nutrition: A Comparison of 2 Protocols

Miller

Donda

Bhutada

et al. 2016

J Parenter Enteral Nutr

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“…A minor limitation is the restriction to preterm infants, but few indications for surfactant therapy exist in older children in other settings. 41,42 Finally, our study was limited by the inability to review common adverse reactions of surfactant administration such as transient bradycardia, hypotension, airway obstruction, and oxygen desaturations.…”

Section: Discussionmentioning

confidence: 99%

Surfactant Administration in Preterm Infants: Drug Development Opportunities

Taylor

Jackson

Hornik

et al. 2019

The Journal of Pediatrics

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Objective: To evaluate how frequently surfactant is used off-label in preterm infants. Study design:We conducted a retrospective cohort analysis of prospectively collected administrative data between 2005 and 2015 from 348 neonatal intensive care units in the United States. We quantified off-label administration of poractant alfa, calfactant, or beractant in inborn infants <37 weeks gestational age. Off-label surfactant administration was defined according to the Food and Drug Administration (FDA) label.Results: Of 110,822 preterm infants who received surfactant, 68,226 (62%) received surfactant off-label. The majority of infants who received surfactant off-label had a higher birth weight than label (40,716 [37%]), had a later gestational age than label (35,191 [32%]), or were intubated and administered surfactant followed by immediate extubation (INSURE) (32,310 [29%]). Poractant alfa was administered via INSURE more frequently than beractant or calfactant (16,688 [38%]; 7137 [20%]; 8485 [27%], respectively). An increasing number of infants received surfactant via INSURE from 2005 to 2015 (1697 [19%]; 3368 [36%]). Conclusions:The majority of surfactant given to preterm infants is administered off-label. The uptrend in administration via INSURE coincides with increased supporting evidence. The gap between FDA labelling and current clinic practice exemplifies an opportunity for label expansion, which may require additional prospective or retrospective safety and/or effectiveness data for infants with later gestational age and higher birth weight.Surfactant is one of the most frequently used medications in neonatal intensive care units (NICUs). 1 Beractant, calfactant, and poractant alfa, animal derived surfactants, are labeled

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“…The mentioned diseases such as MAS, CDH, and pneumonia are characterized by secondary pulmonary surfactant deficiency as indicated in the literature. 34…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Morbidities and Complications of Neonatal İntensive Care Unit Patients with Respiratory Disorders at Different Gestational Ages

Yarcı

Canpolat

2021

Am J Perinatol

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Objective Respiratory distress presented within the first few days of life is life-threatening and common problem in the neonatal period. The aim of this study is to estimate (1) the incidence of respiratory diseases in newborns and related mortality; (2) the relationship between acute neonatal respiratory disorders rates and gestational age, birth weight, and gender; and (3) the incidence of complications associated with respiratory disturbances. Study Design Only inborn patients with gestational age between 230/7 and 416/7 weeks having respiratory distress were included in the study. The data were collected from the medical records and gestational age was based on the menstrual dating. Results There were 8,474 live births between January 1, 2013 and June 30, 2013 in our hospital. A total of 1,367 newborns were hospitalized and oxygen therapy was applied in 903 of them because of respiratory distress. An acute respiratory disorder was found to be in 10.6% (903/8,474) among all live births. Mortality was 0.76% (66/8,474). The incidence of respiratory distress syndrome was 2.8% (n = 242). The occurrence of transient tachypnea of newborn was 3.1% (n = 270). Meconium aspiration syndrome, pneumonia, congenital diaphragmatic hernia, and pulmonary maladaptation and primary persistent pulmonary hypertension rates were 0.1, 0.7, 2.2, and 0%, respectively. Overall, 553 (61%) of the 903 newborns having respiratory diseases had complications. The occurrence of necrotizing enterocolitis, patent ductus arteriosus, bronchopulmonary dysplasia, intraventricular hemorrhage and air leak was 6.8, 19.8, 4.7, 24.9, and 5%, respectively. Conclusion This study offers an epidemiological perspective for respiratory disorders from a single-center level-III neonatal intensive care unit. Although number of births, premature newborns, extremely low birth weight/very low birth weight infants, and complicated pregnancies increase in years, decreasing rates of mortality and complications are very promising. As perinatal and neonatal cares are getting better in every day, we think that more promising results can be achieved over the coming years. Key Points

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The Role of Surfactant Therapy in Nonrespiratory Distress Syndrome Conditions in Neonates

Cited by 11 publications

References 40 publications

Transitioning Preterm Infants From Parenteral Nutrition: A Comparison of 2 Protocols

Transitioning Preterm Infants From Parenteral Nutrition: A Comparison of 2 Protocols

Surfactant Administration in Preterm Infants: Drug Development Opportunities

Evaluation of Morbidities and Complications of Neonatal İntensive Care Unit Patients with Respiratory Disorders at Different Gestational Ages

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