Laryngeal Mask Airway Used as a Delivery Conduit for the Administration of Surfactant to Preterm Infants with Respiratory Distress Syndrome

Trevisanuto, Daniele; Grazzina, Nicoletta; Ferrarese, P.; Micaglio, Massimo; Verghese, C.; Zanardo, Vincenzo

doi:10.1159/000083370

Cited by 118 publications

(80 citation statements)

References 22 publications

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“…The policy of the unit during this period was to administer surfactant treatment to infants (by laryngeal mask airway or intubated) for RDS. 24 Neonatal morbidity included RDS and CLD. RDS was defined by the need for supplemental oxygen and ventilation support and by the characteristic radiographic findings.…”

Section: Methodsmentioning

confidence: 99%

Preterm premature rupture of membranes, chorioamnion inflammatory scores and neonatal respiratory outcome

Zanardo¹,

Vedovato²,

Cosmi

et al. 2009

BJOG

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Objective To evaluate whether histological chorioamnionitis (HCA), in the setting of preterm premature rupture of membranes (PPROM), affects infant respiratory outcome.Design A prospective histological study on 287 consecutive placentas was performed in preterm infants (£32 +6 weeks gestation), categorised into four groups: according to the presence or absence of HCA, in the setting or in absence of PPROM. Results Among the 287 NICU admitted preterm infants, 68/287 (23.6%) presented with HCA, 16/68 (23.5%) with a coexisting fetal inflammatory response, and 74/287 (25.7%) with PPROM. HCA was associated with a greater frequency of vaginal delivery (P < 0.0001), lower gestational age (P < 0.0001) and lower birth weight (P < 0.01). HCA had no effect on fetal lung maturation, however, it was a significant risk factor for CLD (RR; 95% CI 2.08; 1.30-3.33). HCA and the fetal inflammatory response were also significant risk factors for PPROM (RR; 95% CI 2.07; 1.42-3.03 and 2.64; 1.71-4.09 respectively). Conversely, HCA in the setting of PPROM failed to reveal any RDS protection or subtype CLD risk. Multivariate analysis demonstrated significant independent effects of presence of maternal HCA (P = 0.04), gestational age (P < 0.0001) and interaction HCA-gestational age (P = 0.04) on CLD development, regardless of the presence of fetal HCA or fetal HCA-gestational age interaction, PPROM or PPROM-gestational age interaction.Conclusions Histological chorioamnionitis is a significant PPROM and CLD risk factor, but it fails to provide any protection from RDS. HCA in the setting of PPROM also failed to reveal any RDS protection or subtype CLD risk.Keywords Chronic lung disease, fetal inflammatory response syndrome, histological chorioamnionitis, preterm premature rupture of membranes, respiratory distress syndrome.Please cite this paper as: Zanardo V, Vedovato S, Cosmi E, Litta P, Cavallin F, Trevisanuto D, Chiarelli S. Preterm premature rupture of membranes, chorioamnion inflammatory scores and neonatal respiratory outcome. BJOG 2010;117:94-98.

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Section: Methodsmentioning

confidence: 99%

Preterm premature rupture of membranes, chorioamnion inflammatory scores and neonatal respiratory outcome

Zanardo¹,

Vedovato²,

Cosmi

et al. 2009

BJOG

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“…[49][50][51][52] The INSURE method involves a short intubation to administer surfactant followed by extubation to continuous positive airway pressure (CPAP). 49 Pharyngeal deposition of surfactant soon after birth has been reported by Kattwinkel and colleagues, 50 and in Italy Trevisanuto et al 51 used a laryngeal mask to deliver surfactant, both with some success although the results of randomized trials are awaited. At a recent meeting in Ancona, Herting et al presented a poster on surfactant administration in spontaneously breathing infants using a fine gastric tube.…”

mentioning

confidence: 99%

Surfactants: past, present and future

2008

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In 1929 Kurt von Neergaard performed experiments suggesting the presence of pulmonary surfactant and its relevance to the newborn's first breath. Almost 25 years later, Richard Pattle, John Clements and Chris Macklin, each working on the effects of nerve gases on the lungs, contributed to the understanding of the physiology of pulmonary surfactant. About 5 years later Mary Ellen Avery and Jere Mead published convincing evidence that preterm neonates dying of hyaline membrane disease (respiratory distress syndrome, RDS) had a deficiency of pulmonary surfactant. The first trials of nebulized synthetic (protein-free) surfactant to prevent RDS were published soon after Patrick Bouvier Kennedy (son of President John F Kennedy) died of this disorder after treatment in Boston. These trials were unsuccessful; however, Goran Enhorning and Bengt Robertson in the early 1970s demonstrated that natural surfactants (containing proteins) were effective in an immature rabbit model of RDS. Soon after this Forrest Adams showed that a natural surfactant was also effective in an immature lamb model. Working with him was Tetsuro Fujiwara who 2 years later, after returning to Japan, published the seminal article reporting the responses of 10 preterm infants with RDS to a bolus of modified bovine surfactant. During the 1980s there were numerous randomized controlled trials of many different natural and synthetic surfactants, demonstrating reductions in pulmonary air leaks and neonatal mortality. Subsequently natural surfactants were shown to be superior to the protein-free synthetic products. Recently there have been a number of randomized trials comparing different natural surfactant preparations. Commercially available bovine surfactants may have similar efficacy but there is some evidence that a porcine surfactant used to treat RDS with an initial dose of 200 mg kg À1 is more effective than a bovine surfactant used in an initial dose of 100 mg kg -1 . Bovine and porcine surfactants have not been compared in trials of prophylaxis. Very recently a new synthetic surfactant with a surfactant protein mimic has been compared with other commercially available natural and synthetic surfactants in two trials. The new surfactant may be superior to one of the older protein-free synthetic surfactants but there is no evidence of its superiority over established natural products and it is currently not approved for clinical use. A number of other new synthetic surfactants have been tested in animal models or in treatment of adults with ARDS, but so far there have been no reports of treatment of neonatal RDS. Natural surfactants work best if given by a rapid bolus into the lungs but less invasive methods such as a laryngeal mask, pharyngeal deposition or rapid extubation to CPAP have showed promise. Unfortunately, delivery of surfactant by nebulization has so far been ineffective. Surfactant treatment has been tried in a number of other neonatal respiratory disorders but only infants with meconium aspiration seem to benefit although larger and mo...

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“…This has led to a search for alternative strategies of providing exogenous surfactant using noninvasive or minimally invasive techniques which essentially avoid the use of an endotracheal tube; collectively labelled as 'minimally invasive surfactant therapy' (MIST) [Gupta and Donn, 2012]. These include pharyngeal instillation of surfactants [Kattwinkel et al 2004], administration via laryngeal mask airway [Trevisanuto et al 2005] and administration via a thin endotracheal catheter/feeding tube [Dargaville et al 2011]. The protocols for using these techniques are described in the individual publications but these are observational studies and their safety and efficacy is still not validated in controlled trials, and hence not generalizable to other units.…”

Section: Exogenous Surfactant Replacement Therapymentioning

confidence: 99%

Adjunctive drug therapies for treatment of respiratory diseases in the newborn: based on evidence or habit?

Sinha

Tin

2014

Ther Adv Respir Dis

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Abstract:Respiratory distress syndrome is a disease of prematurity and is caused by a relative deficiency of endogenous surfactant production. Respiratory distress syndrome is the most common cause of mortality and morbidity in the newborn population and the standard of care is to provide exogenous surfactant therapy. This saves lives and reduces respiratory complications but, despite treatment, a significant proportion of these infants go onto develop chronic lung disease, the severest form of which is bronchopulmonary dysplasia. Once developed, this is a multisystem disease and treatment is mostly supportive by using various therapeutic adjuncts. Some of these have been proven to be safe and effective in large randomized, controlled trials but similar evidence for other drugs is lacking. The aim of this paper is to provide an overview and critically appraise the available scientific evidence for or against their use in routine practice.

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Laryngeal Mask Airway Used as a Delivery Conduit for the Administration of Surfactant to Preterm Infants with Respiratory Distress Syndrome

Cited by 118 publications

References 22 publications

Preterm premature rupture of membranes, chorioamnion inflammatory scores and neonatal respiratory outcome

Preterm premature rupture of membranes, chorioamnion inflammatory scores and neonatal respiratory outcome

Surfactants: past, present and future

Adjunctive drug therapies for treatment of respiratory diseases in the newborn: based on evidence or habit?

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