Effect of surfactant therapy using an orogastric tube for tracheal catheterization in preterm newborns with respiratory distress

Abstract

Introduction: Respiratory distress syndrome (RDS) due to surfactant deficiency requires surfactant therapy for which InSurE method (Intubate, Surfactant, Extubate) has been widely used. However this method requires intubation and positive pressure ventilation, even for a short time which is enough to initiate significant lung injury. Recently, surfactant administration by Minimally Invasive Surfactant Therapy (MIST) using a fine catheter under direct laryngoscopy in spontaneously breathing preterms while on nCPAP has reported good outcomes. We prospectively assessed the outcome of a modified MIST method of surfactant administration using an orogastric tube in preterms with RDS. Materials & Methods: A single centre, prospective observational study was conducted where all consecutive eligible inborn preterm neonates with gestation age more than 24 weeks but less than 34 weeks and suffering from RDS were enrolled to receive surfactant using MIST. Results were compared with a historical cohort of preterm who received surfactant with INSURE techniques. Results: Sixty four cases in the modified MIST group were compared with a historic cohort of 68 cases in INSURE group. There were no differences in the requirement of intubation and mechanical ventilation in the first 72 hours but the duration of MV and CPAP were significantly less in modified MIST group. Other neonatal morbidities and mortality rates were similar in either of the groups. Conclusion: The modified MIST technique is an effective method for the treatment of RDS in preterms with better clinical efficacy and comparable outcomes than the more invasive INSURE procedure and deserves further evaluation.

Comparison of minimally invasive surfactant therapy with intubation surfactant administration and extubation for treating preterm infants with respiratory distress syndrome: a randomized clinical trial

“…There was no difference in terms of the frequency and duration of mechanical ventilation between the two groups. Nonetheless, Tomar et al 25) reported less mechanical ventilation time for preterm infants born at 34 weeks' gestational age or less in MIST group. Aldana-Aguirre et al 11) and Bugter et al 27) confirmed less need for mechanical ventilation in MIST.…”

“…13) with 30% in MIST and 25% in INSURE as well as other studies. 25,26) However, Dargaville et al 15) showed that although intubation was less needed in MIST group for infants at 25 to 28 weeks of gestational age, there was no significant difference in infants at 29 to 32 weeks of gestational age.…”

Clinical Outcomes of Minimally Invasive Surfactant Therapy via Tracheal Catheterization in Neonates with a Gestational Age of 30 Weeks or More Diagnosed with Respiratory Distress Syndrome

“…However, if neonates who received only noninva sive As observed in previous studies 10,11) , the rate of application of mechanical ventilation was significantly reduced by the LISA method in this study; that is, it was lower in the MIST group than in the control group. Tomar et al 22) published a study using . MIST does not require endotracheal intuba tion;…”