Aerosolized surfactant in neonatal respiratory distress syndrome: Phase I study

Sood, Beena G.; Cortez, Josef; Kolli, Madhuri; Sharma, Amit; Delaney‐Black, Virginia; Chen, Xinguang

doi:10.1016/j.earlhumdev.2019.05.005

Cited by 39 publications

(34 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Some clinical studies have tried to investigate the possibility of nebulizing drugs in spontaneously breathing premature infants during nCPAP with inconclusive results [ 3 , 4 , 5 , 6 , 7 , 8 ]. These studies have shown that delivering nebulized medications to premature infants is a safe procedure, but only two studies have shown signs of therapeutic efficacy [ 3 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the administration of pharmacological therapies by nebulization has been envisaged as the ideal combination to noninvasive respiratory support for targeting the immature lung [ 2 ]. Surfactant replacement therapy is a good example of such an approach: several clinical studies have attempted to deliver nebulized surfactant [ 3 , 4 , 5 , 6 , 7 , 8 ], although the efficacy of this delivery method remains inconclusive in part due to the lack of control of the surfactant aerosol dose delivered to the lung [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Compartment-Based Mathematical Model for Studying Convective Aerosol Transport in Newborns Receiving Nebulized Drugs during Noninvasive Respiratory Support

Tarantini

Milesi

Murgia³

et al. 2020

Pharmaceutics

View full text Add to dashboard Cite

Nebulization could be a valuable solution to administer drugs to neonates receiving noninvasive respiratory support. Small and irregular tidal volumes and air leaks at the patient interface, which are specific characteristics of this patient population and are primarily responsible for the low doses delivered to the lung (DDL) found in this application, have not been thoroughly addressed in in vitro and in vivo studies for quantifying DDL. Therefore, we propose a compartment-based mathematical model able to describe convective aerosol transport mechanisms to complement the existing deposition models. Our model encompasses a mechanical ventilator, a nebulizer, and the patient; the model considers the gas flowing between compartments, including air leaks at the patient–ventilator interface. Aerosol particles are suspended in the gas flow and homogeneously distributed. The impact of breathing pattern variability, volume of the nebulizer, and leaks level on DDL is assessed in representative conditions. The main finding of this study is that convective mechanisms associated to air leaks and breathing patterns with tidal volumes smaller than the nebulizer dramatically reduce the DDL (up to 70%). This study provides a possible explanation to the inconsistent results of drug aerosolization in clinical studies and may provide guidance to improve nebulizer design and clinical procedures.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Compartment-Based Mathematical Model for Studying Convective Aerosol Transport in Newborns Receiving Nebulized Drugs during Noninvasive Respiratory Support

Tarantini

Milesi

Murgia³

et al. 2020

Pharmaceutics

View full text Add to dashboard Cite

show abstract

“…These issues compromise the delivery of surfactant, which is a phospholipid suspension containing natural peptides that are denaturalized by increased temperature. Therefore, clinicians have used jet and vibrating-membrane nebulizers rather than ultrasonic nebulizers for prolonged aerosol therapy (usually for the administration of nebulized surfactant) in spontaneously-breathing premature infants managed with NIV [37,38,[71][72][73][74]. Jet or pneumatic nebulizers use compressed gas to break up liquids into aerosols, usually at gas flows ranging between 4-6 L/min.…”

Section: Table 1 Representative Respiratory Indices Across the Lifespanmentioning

confidence: 99%

Aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learned

et al. 2021

View full text Add to dashboard Cite

Delivery of medications to preterm neonates receiving non-invasive ventilation (NIV) represents one of the most challenging scenarios for aerosol medicine. This challenge is highlighted by the undersized anatomy and the complex (patho)physiological characteristics of the lungs in such infants. Key physiological restraints include low lung volumes, low compliance, and irregular respiratory rates, which significantly reduce lung deposition. Such factors are inherent to premature birth and thus can be regarded to as the intrinsic factors that affect lung deposition. However, there are a number of extrinsic factors that also impact lung deposition: such factors include the choice of aerosol generator and its configuration within the ventilation circuit, the drug formulation, the aerosol particle size distribution, the choice of NIV type, and the patient interface between the delivery system and the patient. Together, these extrinsic factors provide an opportunity to optimize the lung deposition of therapeutic aerosols and, ultimately, the efficacy of the therapy.In this review, we first provide a comprehensive characterization of both the intrinsic and extrinsic factors affecting lung deposition in premature infants, followed by a revision of the clinical attempts to deliver therapeutic aerosols to premature neonates during NIV, which are almost exclusively related to the non-invasive delivery of surfactant aerosols. In this review, we provide clues to the interpretation of existing experimental and clinical data on neonatal aerosol delivery and we also describe a frame of measurable variables and available tools, including in vitro and in vivo models, that should be considered when developing a drug for inhalation in this important but under-served patient population.

show abstract

“…So, it seems that a combination of early respiratory support and prescription of surfactant may improve the treatment results. Administration of surfactant during NCPAP, less-invasive (LISA) and minimalinvasive surfactant administration (MISA) have shown convenient results in management of NRDS [47].…”

Section: Mechanical Ventilationmentioning

confidence: 99%

“…Recently published studies have introduced the aerosolized surfactant as a safe and efficient method of drug delivery [47]. It has been claimed that vibrating and ultrasonic mesh nebulizers have the ability to make surfactant aerosols without interfering with biochemical composition of medication [48][49][50].…”

Section: Mechanical Ventilationmentioning

confidence: 99%

Neonatal Respiratory Distress Syndrome: Things to Consider and Ways to Manage

Najafian¹,

Khosravi²

2020

Update on Critical Issues on Infant and Neonatal Care

View full text Add to dashboard Cite

Involving more commonly the premature (less than 37 weeks of gestational age) infants, neonatal respiratory distress syndrome is an important clinical syndrome responsible for a high rate of mortality and morbidity. The main progress in respiratory distress syndrome (RDS) management is attributable to prescription of surfactant for fastening pulmonary maturation. Respiratory protection, such as mechanical ventilation and nasal continuous positive airway pressure, and surfactant are building blocks of disease treatment. In this chapter, we are going to have a rapid review on epidemiology, diagnosis and treatments of RDS.

show abstract

Aerosolized surfactant in neonatal respiratory distress syndrome: Phase I study

Cited by 39 publications

References 51 publications

A Compartment-Based Mathematical Model for Studying Convective Aerosol Transport in Newborns Receiving Nebulized Drugs during Noninvasive Respiratory Support

A Compartment-Based Mathematical Model for Studying Convective Aerosol Transport in Newborns Receiving Nebulized Drugs during Noninvasive Respiratory Support

Aerosol drug delivery to spontaneously-breathing preterm neonates: lessons learned

Neonatal Respiratory Distress Syndrome: Things to Consider and Ways to Manage

Contact Info

Product

Resources

About