Early administration of surfactant in spontaneous breathing with nCPAP: feasibility and outcome in extremely premature infants (postmenstrual age ≤27 weeks)

Kribs, Angela; Pillekamp, Frank; Hünseler, Christoph; Vierzig, Anne; Roth, Bernhard

doi:10.1111/j.1460-9592.2006.02126.x

Cited by 210 publications

(216 citation statements)

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“…Verder et al first published the results of their study on surfactant administration through a thin catheter in infants capable of spontaneous breathing in 1992 (21). However, this technique was first used as a treatment option in 2001 and the first serious study on the feasibility of this technique and its patient prognosis was published in 2007 (22,23 This technique appears to quickly improve infants 'physiological conditions and reduce their need for FiO 2 and mechanical ventilation and their duration of oxygen treatment (17).…”

Section: Discussionmentioning

confidence: 99%

A Randomized Trial Comparing Surfactant Administration Using InSurE Technique and the Minimally Invasive Surfactant Therapy in Preterm Infants (28 to 34 Weeks of Gestation) with Respiratory Distress Syndrome

et al. 2017

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Background: The present study was conducted to investigate and compare the effectiveness of the minimally invasive surfactant therapy (MIST) and the INSURE technique (Intubation, Surfactant administration, and extubation) in spontaneously breathing preterm infants. Methods: Preterm infants (28-34 weeks of gestation) born with respiratory distress syndrome between April 2013 and February 2014 were randomly selected to receive 200 mg/kg of surfactant (Curosurf) using either MIST or INSURE techniques. In the MIST group, surfactant was instilled via a thin tracheal catheter (5-f) that was then removed. In the INSURE group, the infants were first intubated, administered surfactant through passing a feeding tube through the endotracheal tube, and then extubated after 30 seconds of positive pressure ventilation. Nasal CPAP for respiratory support continued in both groups after performing the procedures. The amounts of supplemental oxygen required, intensive care requirements, and outcomes were compared between the two groups. Results: The present study examined 27 infants in the MIST group and 26 in the INSURE group. The amount of oxygen required by

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Section: Discussionmentioning

confidence: 99%

A Randomized Trial Comparing Surfactant Administration Using InSurE Technique and the Minimally Invasive Surfactant Therapy in Preterm Infants (28 to 34 Weeks of Gestation) with Respiratory Distress Syndrome

et al. 2017

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“…New research on the differences between the allelic variants of the surfactant protein genes is leading to the understanding of individual susceptibility to the development of pulmonary diseases in the neonates. 30 Randomised controlled trials to evaluate the efficacy of combining prophylactic surfactant and early nasal continuous positive airway pressure in preterm infants 31,32 also need to be done in our country to evaluate and establish the most effective and safest interventions for preterm neonates at risk of developing RDS and associated morbidities. …”

Section: Discussionmentioning

confidence: 99%

Role of prophylactic surfactant in preterm infants

Singh¹,

Rana²,

Mathai

2011

Medical Journal Armed Forces India

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INTRODUCTIONRespiratory distress syndrome (RDS) in preterm neonates is caused by a deficiency or dysfunction of pulmonary surfactant. Surfactant lines the alveolar surface and prevents atelectasis at end expiration. Pulmonary surfactant is predominantly dipalmitoylphosphatidylcholine with lesser amounts of other phospholipids including phosphatidylglycerol, phosphatidylethanolamine, and phosphatidylinositol. Pulmonary surfactant also contains neutral lipids and distinct surfactant proteins. The physiologic function of surfactant includes the ability to lower surface tension, as well as the ability to rapidly adsorb and spread, associated with the respiratory cycle. The first attempts to utilise synthetic surfactants occurred in the 1960s. The first successful animal model of surfactant replacement therapy was conducted by Enhorning and coworkers in 1972. Enhorning administered a crude natural surfactant extract obtained from lavage of the lungs of mature rabbits 1 directly into the trachea of immature rabbits. Improvement in lung compliance and alveolar expansion was noted. Success in animal models led to widespread clinical trials of surfactant therapy in the human newborns. A systematic review of the seven randomised controlled trials that compare the prophylactic administration of synthetic surfactant to control treatment in preterm infants at risk of developing RDS suggests that prophylactic administration of synthetic surfactant leads to a significant decrease in the risk of pneumothorax, pulmonary interstitial emphysema, and neonatal mortality.2-4 So far, no trials of prophylactic surfactant in preterm neonates were carried out in our country because of the prohibitive cost of the imported drug. During the last decade, preparations of exogenous surfactant have been marketed in our country. This has made it possible to evaluate the prophylactic role of surfactant in preventing respiratory distress syndrome and its associated morbidities in preterm neonates. The present study was designed to find out whether prophylactic administration of surfactant leads to a significant decrease in the risk of neonatal mortality and neonatal morbidity. MATERIALS AND METHODSThis was an experimental study in which a total of 125 preterm newborns less than 34 weeks gestation were studied. The study was carried out in two phases from December 2003 to November 2006. The inclusion criteria were designed to include newborn babies who were less than 34 weeks gestational age at the time of birth. The gestational age assessment was Role of prophylactic surfactant in preterm infants

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“…In this study, we showed the feasibility and an improvement of outcomes of the study group compared with a historical control group. 8 The need for mechanical ventilation because of RDS was reduced from 77% in the historical control group to 48% in the study group. Mortality decreased from 35 to 12% and the rate of severe IVH in survivors from 32 to 5%.…”

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confidence: 95%

Potential confounder of NEC clinical trials

2009

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With great interest we read the article 'Surfactants: past, present and future' by HL Halliday. 1 This article describes very well the unique success story of this wonderful substance that has not yet been finished. We were surprised to read about 'surfactant administration in spontaneously breathing infants using a fine gastric tube' as a single report at a meeting. In our German literature, this method has been more extensively reported. At our center, we developed and introduced this method for the first time. This method combines the positive effects of nCPAP and surfactant. The underlying idea is that inspiring surfactant is more physiologically appropriate than receiving it by positive pressure inflations as with the INSURE procedure. We reported the results in 2003 at the annual meeting of the GNPI (Gesellschaft fü r Neonatologie und Pädiatrische IntensivmedizinFSociety for Neonatology and Pediatric Intensive Care) in Cologne. 2 This method was a topic of discussion at the annual meetings of the GNPI in the following years too. 3-7 Therefore, we performed a pilot study in infants with a gestational age below 27 0=7 weeks. In this study, we showed the feasibility and an improvement of outcomes of the study group compared with a historical control group. 8 The need for mechanical ventilation because of RDS was reduced from 77% in the historical control group to 48% in the study group. Mortality decreased from 35 to 12% and the rate of severe IVH in survivors from 32 to 5%. These results, combined with subsequent experiences, were published this year. 9 The data confirmed the results of the original feasibility study. Our ongoing randomized controlled trials utilizing this technique are registered (AMV trial ISRCTN 05025922, NINSAPP trial ISRCTN 64011614), but the results are not yet available.

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Early administration of surfactant in spontaneous breathing with nCPAP: feasibility and outcome in extremely premature infants (postmenstrual age ≤27 weeks)

Abstract: Surfactant administration during nCPAP is feasible. First results indicate that early complications are rare. This warrants a prospective randomized trial.

Cited by 210 publications

References 10 publications

A Randomized Trial Comparing Surfactant Administration Using InSurE Technique and the Minimally Invasive Surfactant Therapy in Preterm Infants (28 to 34 Weeks of Gestation) with Respiratory Distress Syndrome

A Randomized Trial Comparing Surfactant Administration Using InSurE Technique and the Minimally Invasive Surfactant Therapy in Preterm Infants (28 to 34 Weeks of Gestation) with Respiratory Distress Syndrome

Role of prophylactic surfactant in preterm infants

Potential confounder of NEC clinical trials

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