Early administration of surfactant via a thin intratracheal catheter in preterm infants with respiratory distress syndrome: Feasibility and outcome

Abstract

Objective:Currently, the method of early nasal continuous positive airway pressure (nCPAP) and selective administration of surfactant via an endotracheal tube is widely used in the treatment of respiratory distress syndrome (RDS) in premature infants. To prevent complications related to endotracheal intubation and even a brief period of mechanical ventilation, in this study, we compared the effectiveness of surfactant administration via a thin intratracheal catheter versus the current method using an endotracheal tube.Methods:Thirty eight preterm infants ≤34 weeks' gestation with birth weight of 1000–1800 g who were putted on nCPAP for RDS within the first hour of life, were randomly assigned to receive surfactant either via endotracheal tube (ET group) or via thin intratracheal catheter (CATH group). The primary outcomes were the need for mechanical ventilation and duration of oxygen therapy. Data were analyzed by independent t-test, Mann-Whitney U-test, and Chi-square test, using SPSS v. 21.Findings:There was no significant difference between groups regarding to need for mechanical ventilation during the first 72 h of birth (3 [15.8%] in ET group vs. 2 [10.5%] in CATH group; P = 0.99). Duration of oxygen therapy in CATH group was significantly lower than ET group (243.7 ± 74.3 h vs. 476.8 ± 106.8 h, respectively; P = 0.018). The incidence of adverse events during all times of surfactant administration was not statistically significant between groups (P = 0.14), but the number of infants who experienced adverse events during surfactant administration was significantly lower in CATH group than ET group (6 [31.6%] vs. 12 [63.2%], respectively; P = 0.049). All other outcomes, including duration of treatment with CPAP and mechanical ventilation, times of surfactant administration and the need for more than one dose of the drug, the rate of intraventricular hemorrhage, mortality and combined outcome of chronic lung disease or mortality were statistically similar between the groupsConclusion:Surfactant administration via thin intratracheal catheter in preterm infants receiving nCPAP for treatment of RDS has similar efficacy, feasibility and safety to its administration via endotracheal tube.

Impact of Minimally Invasive Surfactant Therapy in Preterm Infants at 29-32 Weeks Gestation

“…It should be emphasised that these improvements occurred despite surfactant delivery by the Hobart method occurring relatively late, at a median of 10 h, and only being applied to a minority of infants admitted at 29-32 weeks gestation. In these aspects, our study is at odds with several published studies of minimally invasive surfactant therapy in infants of similar gestation, in which around two-thirds of infants achieved the trial entry thresholds (FiO 2 0.30 or 0.35) at a very early age (<2 h) [12,13]. …”

“…Findings of one observational study were consistent with this, with a low proportion of infants beyond 28 weeks gestation receiving surfactant treatment via thin catheter [8]. By contrast, other studies including infants at gestations above 28 weeks have reported that the majority of infants on CPAP qualified for the intervention [12,13], contrary to our experience at this gestation [6]. Full evaluation of the selective use of minimally invasive surfactant therapy should include information on what proportion of infants within the gestational age cohort qualified for the therapy, and of those, how many actually received it.…”

“…The published evidence in relation to minimally invasive surfactant therapy is characterised by a paucity of clinical trials [9,11,12,13,14,15] and a surfeit of meta-analyses [18,19,20,21,22], with the overall impression being that surfactant is more effective when delivered via a thin catheter to a spontaneously breathing infant, rather than via an endotracheal tube with positive pressure ventilation. Only around 250 of the 895 infants thus far studied have been in the gestation range of 29-32 weeks [9,12,13,14], and none of the trials including infants at this gestation have compared surfactant administration using a minimally invasive approach with continuation of CPAP.…”

“…Only around 250 of the 895 infants thus far studied have been in the gestation range of 29-32 weeks [9,12,13,14], and none of the trials including infants at this gestation have compared surfactant administration using a minimally invasive approach with continuation of CPAP. Whilst results exclusively for infants at 29-32 weeks gestation are not available, overall the 4 studies that included infants in this gestation range [9,12,13,14] showed benefits of surfactant delivery via thin catheter over administration via endotracheal tube, including a reduction in the need for subsequent intubation and in the risk of death or BPD [19]. Our data suggest that an improvement in the latter outcome may be less realistic for NICUs already achieving very high survival without BPD in infants beyond 28 weeks gestation.…”

“…In an effort to improve the chance of successful CPAP application, techniques of minimally invasive surfactant therapy have been developed whereby surfactant is instilled into the lung using a thin catheter [8,9,10]. Randomised controlled trials have shown some advantages of this approach compared with intubation for surfactant [9,11,12,13,14] or continuation of CPAP [15], although most infants in these studies have been <29 weeks gestation. …”