Treatment of MAS with PPHN using combined therapy: SLL, bolus surfactant and iNO

Gadzinowski, Janusz; Kowalska, Katarzyna; Vidyasagar, D.

doi:10.1038/jp.2008.163

Cited by 29 publications

(10 citation statements)

References 20 publications

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“…A comparison of various surfactant treatment regimens in MAS did not find the superiority of one form of therapy over another, and may be related to the heterogeneous nature of this form of lung injury [54]. In an underpowered randomized trial comparing bolus (N=6) versus surfactant lavage (N=7) followed by inhaled nitric oxide, infants receiving surfactant lavage has significant improvements in oxygenation, decreases in mean airway pressure, and arterial-alveolar oxygen tension gradients; however there were no significant differences in duration of assisted ventilation, nitric oxide therapy, or hospitalization[55]. …”

Section: Introductionmentioning

confidence: 99%

An overview of pulmonary surfactant in the neonate: Genetics, metabolism, and the role of surfactant in health and disease

Nkadi

Merritt

Pillers

2009

Molecular Genetics and Metabolism

169

127

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Pulmonary surfactant is a complex mixture of phospholipids (PL) and proteins (SP) that reduce surface tension at the air-liquid interface of the alveolus. It is made up of about 70% to 80% PL, mainly dipalmitoylphosphatidylcholine (DPPC), 10% SP-A, B, C and D, and 10% neutral lipids, mainly cholesterol. Surfactant is synthesized, assembled, transported and secreted into the alveolus where it is degraded and then recycled. Metabolism of surfactant is slower in newborns, especially preterm, than in adults. Defective pulmonary surfactant metabolism results in respiratory distress with attendant morbidity and mortality. This occurs due to accelerated breakdown by oxidation, proteolytic degradation, inhibition or inherited defects of surfactant metabolism. Prenatal corticosteroids, surfactant replacement, whole lung lavage and lung transplantation have yielded results in managing some of these defects. Gene therapy could prove valuable in treating inherited defects of surfactant metabolism.

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Section: Introductionmentioning

confidence: 99%

An overview of pulmonary surfactant in the neonate: Genetics, metabolism, and the role of surfactant in health and disease

Nkadi

Merritt

Pillers

2009

Molecular Genetics and Metabolism

169

127

View full text Add to dashboard Cite

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“…As an alternative approach a regimen consisting of dilute surfactant lavage followed by bolus surfactant therapy (100 mg/kg) has been compared with bolus surfactant only in a small clinical trial [33]. Those infants receiving lavage (n = 7) showed more rapid improvement in oxygenation and reduction in mean airway pressure than the 6 infants treated with bolus surfactant only.…”

Section: Surfactant Lavage Therapymentioning

confidence: 99%

“…Experience of surfactant lavage in human infants consists of case reports (reviewed previously [9]), non-randomised studies with concurrent or historical control groups [13,18,24,25,26,27,28,29,30], two randomised controlled trials (RCTs) comparing surfactant lavage with standard care [31,32] as well as a small RCT comparing surfactant lavage followed by bolus surfactant therapy with bolus surfactant alone [33]. A systematic review and meta-analysis of the non-randomised studies and RCTs is now available [34].…”

Section: Surfactant Lavage Therapymentioning

confidence: 99%

Innovation in Surfactant Therapy I: Surfactant Lavage and Surfactant Administration by Fluid Bolus Using Minimally Invasive Techniques

Dargaville¹

2012

Neonatology

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Innovation in the field of exogenous surfactant therapy continues more than two decades after the drug became commercially available. One such innovation, lung lavage using dilute surfactant, has been investigated in both laboratory and clinical settings as a treatment for meconium aspiration syndrome (MAS). Studies in animal models of MAS have affirmed that dilute surfactant lavage can remove meconium from the lung, with resultant improvement in lung function. In human infants both non-randomised studies and two randomised controlled trials have demonstrated a potential benefit of dilute surfactant lavage over standard care. The largest clinical trial, performed by our research group in infants with severe MAS, found that lung lavage using two 15-ml/kg aliquots of dilute surfactant did not reduce the duration of respiratory support, but did appear to reduce the composite outcome of death or need for extracorporeal membrane oxygenation. A further trial of lavage therapy is planned to more precisely define the effect on survival. Innovative approaches to surfactant therapy have also extended to the preterm infant, for whom the more widespread use of continuous positive airway pressure (CPAP) has meant delaying or avoiding administration of surfactant. In an effort to circumvent this problem, less invasive techniques of bolus surfactant therapy have been trialled, including instillation directly into the pharynx, via laryngeal mask and via brief tracheal catheterisation. In a recent clinical trial, instillation of surfactant into the trachea using a flexible feeding tube was found to reduce the need for subsequent intubation. We have developed an alternative method of brief tracheal catheterisation in which surfactant is delivered via a semi-rigid vascular catheter inserted through the vocal cords under direct vision. In studies to date, this technique has been relatively easy to perform, and resulted in rapid improvement in lung function and reduced need for subsequent ventilation and duration of oxygen therapy. We are now commencing large-scale clinical trials of this method in preterm infants on CPAP.

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“…17 Infants with RDS and MAS benefit most from a combination of HFV and iNO therapy. 14,15,18,19 For infants without associated lung disease, hypoxemia is caused by right-to-left shunting rather than by ventilation-perfusion imbalance. Minimizing mean airway pressure and shortening inspiratory time are reasonable therapeutic approaches in this circumstance.…”

Section: Assisted Ventilationmentioning

confidence: 99%

Beyond the inhaled nitric oxide in persistent pulmonary hypertension of the newborn

Lai

Chu

Lakshminrusimha

et al. 2018

Pediatrics & Neonatology

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Persistent pulmonary hypertension (PPHN) is a consequence of failed pulmonary vascular transition at birth and leads to pulmonary hypertension with shunting of deoxygenated blood across the ductus arteriosus (DA) and foramen ovale (FO) resulting in severe hypoxemia, and it may eventually lead to life-threatening circulatory failure. PPHN is a serious event affecting both term and preterm infants in the neonatal intensive care unit. It is often associated with diseases such as congenital diaphragmatic hernia, meconium aspiration, sepsis, congenital pneumonia, birth asphyxia and respiratory distress syndrome. The diagnosis of PPHN should include echocardiographic evidence of increased pulmonary pressure, with demonstrable right-to-left shunt across the DA or FO, and the absence of cyanotic heart diseases. The mainstay therapy of PPHN includes treatment of underlying causes, maintenance of adequate systemic blood pressure, optimized ventilator support for lung recruitment and alveolar ventilation, and pharmacologic measures to increase pulmonary vasodilation and decrease pulmonary vascular resistance. Inhaled nitric oxide has been proved to treat PPHN successfully with improved oxygenation in 60-70% of patients and to significantly reduce the need for extracorporeal membrane oxygenation (ECMO). About 14%-46% of the survivors develop long-term impairments such as hearing deficits, chronic lung disease, cerebral palsy and other neurodevelopmental disabilities.

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Treatment of MAS with PPHN using combined therapy: SLL, bolus surfactant and iNO

Cited by 29 publications

References 20 publications

An overview of pulmonary surfactant in the neonate: Genetics, metabolism, and the role of surfactant in health and disease

An overview of pulmonary surfactant in the neonate: Genetics, metabolism, and the role of surfactant in health and disease

Innovation in Surfactant Therapy I: Surfactant Lavage and Surfactant Administration by Fluid Bolus Using Minimally Invasive Techniques

Beyond the inhaled nitric oxide in persistent pulmonary hypertension of the newborn

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