An Open Label, Pilot Study of Aerosurf<sup>®</sup>Combined with nCPAP to Prevent RDS in Preterm Neonates

Finer, Neil N.; Merritt, T. Allen; Bernstein, Graham; Job, Leela; Mazela, Jan; Segal, Robert

doi:10.1089/jamp.2009.0758

Cited by 144 publications

(129 citation statements)

References 32 publications

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“…Nebulization of surfactant offers an attractive alternative. Unfortunately, studies of nebulized surfactant have shown inconsistent clinical response and surfactant distribution (9)(10)(11)(12)(13)(14)(15)(16). Moreover, most of the studies, even those in which a lung function improvement was observed, reported very low (<10%) fractions of surfactant deposition into the lung (9,12,(17)(18)(19)(20).…”

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confidence: 99%

Intratracheal atomized surfactant provides similar outcomes as bolus surfactant in preterm lambs with respiratory distress syndrome

et al. 2016

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Background: Aerosolization of exogenous surfactant remains a challenge. This study is aimed to evaluate the efficacy of atomized poractant alfa (Curosurf ) administered with a novel atomizer in preterm lambs with respiratory distress syndrome. Methods: Twenty anaesthetized lambs, 127 ± 1 d gestational age, (mean ± SD) were instrumented before birth and randomized to receive either (i) positive pressure ventilation without surfactant (Control group), (ii) 200 mg/kg of bolus instilled surfactant (Bolus group) at 10 min of life or (iii) 200 mg/kg of atomized surfactant (Atomizer group) over 60 min from 10 min of life. All lambs were ventilated for 180 min with a standardized protocol. Lung mechanics, regional lung compliance (electrical impedance tomography), and carotid blood flow (CBF) were measured with arterial blood gas analysis. results: Dynamic compliance and oxygenation responses were similar in the Bolus and Atomizer groups, and both better than Control by 180 min (all P < 0.05; two-way ANOVA). Both surfactant groups demonstrated more homogeneous regional lung compliance throughout the study period. There were no differences in CBF conclusion: In a preterm lamb model, atomized surfactant resulted in similar gas exchange and mechanics as bolus administration. This study suggests evaluation of supraglottic atomization with this system when noninvasive support is warranted. s urfactant replacement therapy is a well-established standard of care for the treatment and prevention of neonatal respiratory distress syndrome (RDS), significantly reducing mortality and morbidity (1). Currently, endotracheal instillation is the only approved method of administration. However, over the last decade, the management of mild to moderate RDS has dramatically changed, endotracheal tube (ETT) intubation is often avoided and infants were managed with noninvasive modalities, such as continuous positive airway pressure whilst spontaneously breathing. In this population, surfactant administration is generally only provided when oxygen requirement increases and intubation is necessary (2,3).The increase in noninvasive ventilation use has led to less invasive methods of surfactant delivery during continuous positive airway pressure being developed (4,5). All reported methods require technical skills, some degree of invasive intervention, and still involve instillation of liquid surfactant directly into the trachea via a process that is not dissimilar to intubation (6-8). Nebulization of surfactant offers an attractive alternative. Unfortunately, studies of nebulized surfactant have shown inconsistent clinical response and surfactant distribution (9-16). Moreover, most of the studies, even those in which a lung function improvement was observed, reported very low (<10%) fractions of surfactant deposition into the lung (9,12,(17)(18)(19)(20). Notwithstanding differences in nebulizer design, and thus particle size production, such modest deposition is likely due to the fact that most studies used aerosols generated extracorporeally by ...

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Intratracheal atomized surfactant provides similar outcomes as bolus surfactant in preterm lambs with respiratory distress syndrome

et al. 2016

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“…Delivery of aerosolized SF (SF-aero) might be a useful alternative to tracheal instillation for the treatment of RDS, but experimental and clinical results with this technique remain inconsistent (6)(7)(8)(9)(10)(11)(12)(13). Discrepancies in the results can be attributed to the use of different animal models of lung injury (neonatal RDS vs. adult RDS), aerosol devices (jet vs. ultrasonic), sites for the placement of the aerosol devices (endotracheal tube vs. nasal prong), and SF preparations (natural vs. synthetic), as well as variations in the doses used.…”

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Acute and sustained effects of aerosolized vs. bolus surfactant therapy in premature lambs with respiratory distress syndrome

et al. 2013

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“…Until now, there have been four clinical studies on nebulized surfactant as rescue therapy (13)(14)(15)(16). These studies confirmed the safety and feasibility of the method.…”

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confidence: 81%

Nebulization of Poractant alfa via a vibrating membrane nebulizer in spontaneously breathing preterm lambs with binasal continuous positive pressure ventilation

et al. 2015

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An Open Label, Pilot Study of Aerosurf^®Combined with nCPAP to Prevent RDS in Preterm Neonates

Abstract: Aerosurf can be safely administered via nCPAP in preterm infants at risk for RDS and may provide an alternative to surfactant administration via an ET tube. Further studies are required to evaluate this delivery approach.

Cited by 144 publications

References 32 publications

Intratracheal atomized surfactant provides similar outcomes as bolus surfactant in preterm lambs with respiratory distress syndrome

Intratracheal atomized surfactant provides similar outcomes as bolus surfactant in preterm lambs with respiratory distress syndrome

Acute and sustained effects of aerosolized vs. bolus surfactant therapy in premature lambs with respiratory distress syndrome

Nebulization of Poractant alfa via a vibrating membrane nebulizer in spontaneously breathing preterm lambs with binasal continuous positive pressure ventilation

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An Open Label, Pilot Study of Aerosurf®Combined with nCPAP to Prevent RDS in Preterm Neonates

Abstract: Aerosurf can be safely administered via nCPAP in preterm infants at risk for RDS and may provide an alternative to surfactant administration via an ET tube. Further studies are required to evaluate this delivery approach.

Cited by 144 publications

References 32 publications

Intratracheal atomized surfactant provides similar outcomes as bolus surfactant in preterm lambs with respiratory distress syndrome

Intratracheal atomized surfactant provides similar outcomes as bolus surfactant in preterm lambs with respiratory distress syndrome

Acute and sustained effects of aerosolized vs. bolus surfactant therapy in premature lambs with respiratory distress syndrome

Nebulization of Poractant alfa via a vibrating membrane nebulizer in spontaneously breathing preterm lambs with binasal continuous positive pressure ventilation

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An Open Label, Pilot Study of Aerosurf^®Combined with nCPAP to Prevent RDS in Preterm Neonates