Minimally Invasive Surfactant Therapy: An Analytical Report of Our Prospective Dubai Cohort

Abstract

Introduction: Type 2 pneumocytes of the respiratory epithelium secrete the endogenous surfactant, a detergent-like substance that lines the alveolar sacs of the lungs. The surfactant facilitates the gas exchange process across the alveolar membrane by preventing the collapse of the alveoli and thereby maintaining their distended state. Respiratory distress syndrome of the premature neonates is characterized by quantitative and/or qualitative defects of endogenous surfactant metabolic pathways. The advent of exogenous surfactant therapy is rightly hailed as the major milestone in advancement of the care of the babies with surfactant-deficient lung disease. The administration of exogenous surfactant traditionally involves endotracheal intubation and mechanical ventilation. Minimally invasive surfactant therapy (MIST) is the technique of delivering surfactant without intubation whilst continuing the baby on noninvasive respiratory support. This author introduced MIST as the default way of administering surfactant in his neonatal units in Dubai and has to his credit the first published report on MIST from the United Arab Emirates in this journal in 2018. Objective: To analyze prospectively all our babies in Dubai who received surfactant by MIST. Design: Prospective descriptive study of all babies receiving surfactant by MIST starting from January 2018. Setting: Three tertiary care neonatal centers in Dubai. Patients and methods: Thirteen babies (gestation 27-36 weeks and birth weight 0.95-2.81 kg) were treated with MIST on 15 occasions. Catheterization techniques were by infant feeding tube in 10 babies, LISA (less invasive surfactant administration) catheter in one baby, and 2.0 size endotracheal tube (ETT) with surfactant filled syringe directly attached to its hub two times each in two babies. Curosurf the porcine surfactant at 200 mg/kg was used on nine occasions and Survanta the bovine surfactant at 4 mL/kg on six occasions. Main outcome measures: MIST success defined as the baby not needing intubation and ventilation within 72 hours post MIST. Outcome measures with respect to the different modalities of MIST procedure and surfactant preparations used in this prospective cohort. Results: Only one of the 13 babies (7.7%) in this cohort needed escalation of support with mechanical ventilation and high frequency oscillation (HFO). MIST using semi-rigid catheters like the LISA catheter or the smallest size ETT was technically easier to perform. No differences were observed with regard to the surfactant preparation used. None had an abnormal neurosonogram and there were no instances of sepsis and necrotizing enterocolitis either. The baby that had an unsuccessful MIST had retinopathy of prematurity that was effectively treated 1

Microbial Biosurfactant as an Alternate to Chemical Surfactants for Application in Cosmetics Industries in Personal and Skin Care Products: A Critical Review

“…Babies born via vaginal delivery have a microbiota analogous to the microbial community that lives in their mother's birth canal [ 84 ]. In contrast, babies born via caesarean section have a microbiota analogous to the microbial population living on their mother's skin surfaces [ 85 ]. After initial colonization, the skin's microbial diversity is typically further expanded by continuous exposure to atmospheric microorganisms, regulated by T lymphocytes, and related host traits like sexuality, environment, nutrition, location, and the usage of personal and cosmetic products [ 86 , 87 ].…”

Less Invasive Surfactant Administration: A Review of Current Evidence of Clinical Outcomes With Beractant

“…Others have noted their expectation to observe higher rates of reflux with largervolume surfactants when utilizing LISA [24]; however, studies of the larger-volume surfactants such as bovine lipid extract surfactant (BLES) and Neosurf (5 mL/kg, 135 mg phospholipids per kg) administered with LISA have generated inconsistent data regarding reflux and reflux-related outcomes [45,56]. Results from chart reviews examining reflux rates with larger-volume beractant versus small-volume poractant administered via LISA have also been inconsistent and were limited, in part, by the small sample size [54,58]. Additional evidence assessing reflux with LISA for different surfactants could help inform efforts for practitioner education and training and should, therefore, also describe relevant LISA administration techniques utilized to proactively minimize this outcome.…”

“…For instance, a proactive technique was used in one of these chart reviews, where the stomach was aspirated before LISA and the surfactant was dispersed during the procedure via air flush until there was no regurgitation evident. No patients receiving either beractant or poractant experienced reflux, potentially due to the use of this technique [58]. So, future evaluations of reflux and bradycardia should consider potential intercenter differences, by describing and adjusting for relevant techniques in their analysis.…”