Prediction of respiratory distress syndrome by the microbubble stability test on gastric aspirates in newborns of less than 32 weeks’gestation

Verder, Henrik; Ebbesen, Finn; Linderholm, Bim; Robertson, Bengt; Eschen, Christian; Arrøe, M; Lange, Aksel; Grytter, Carl; Bohlin, Kajsa; Bertelsen, Aksel

doi:10.1111/j.1651-2227.2003.tb00608.x

Cited by 29 publications

(24 citation statements)

References 23 publications

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“…A rapid test of lung maturity that accurately predicts the risk of developing clinically significant RDS would, in the future, allow for early or prophylactic surfactant treatment of infants at risk. 22 As a mode of surfactant administration, the INSURE approach would then provide a means to avoid potentially harmful MV and possibly reduce the need for transfers of moderately preterm infants to an intensive care facility.…”

Section: Discussionmentioning

confidence: 99%

Implementation of surfactant treatment during continuous positive airway pressure

et al. 2007

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Objective: To study the effects of implementing a method for surfactant administration by transient intubation, INSURE (i.e. INtubation SURfactant Extubation) during nasal continuous positive airway pressure (nCPAP) for moderately preterm infants with respiratory distress syndrome (RDS).Study design: A descriptive, retrospective, bi-center study in Stockholm, Sweden, comparing mechanical ventilation (MV) rates, surfactant use, treatment response and outcome of all inborn infants with gestational age 27 to 34 weeks and RDS, (n ¼ 420), during the 5-year periods before and after the introduction of the INSURE-strategy at one of the centers (Karolinska Huddinge) in 1998. The other center (Karolinska Solna) continued conventional surfactant therapy in conjunction with MV throughout the study.Results: Implementation of INSURE at Karolinska Huddinge reduced the number of infants requiring MV by 50% (P<0.01), resulted in earlier surfactant administration and increased overall surfactant use. INSURE-treatment improved oxygenation and the treatment response was sustained over time with only 17% of the infants requiring >1 dose of surfactant. At Karolinska Solna, the MV rates were unaltered between the first and second 5-year period.Conclusion: Implementing a strategy of surfactant administration by transient intubation during nCPAP reduces the need for MV without adverse effects on outcome and may be an option to more effectively treat RDS, particularly in a care setting where transfer is necessary to provide MV.

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Section: Discussionmentioning

confidence: 99%

Implementation of surfactant treatment during continuous positive airway pressure

et al. 2007

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“…The SMT is a diagnostic test for RDS that has high sensitivity and specificity . The test is based on the fact that surfactant stabilizes microbubbles <15 μm in diameter.…”

Section: Methodsmentioning

confidence: 99%

Oxygen requirement and surfactant therapy in preterm infants after delivery

Toriyama

Ishiguro

Motojima

et al. 2014

Pediatrics International

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“…Verder et al [17] used computerized image analyses of the average diameter of microbubbles generated in gastric aspirates to predict RDS in newborns <32 weeks' gestation supported by CPAP soon after birth and found that microbubbles <20 or 25 µm were most predictive of RDS. Fiori et al [15] found the best microbubble count for the diagnosis of RDS was <15/mm 2 .…”

Section: Discussionmentioning

confidence: 99%

The Stable Microbubble Test for Determining Continuous Positive Airway Pressure (CPAP) Success in Very Preterm Infants Receiving Nasal CPAP from Birth

et al. 2013

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Background: Very preterm infants can be treated with nasal continuous positive airway pressure (CPAP) from birth, but some fail. A rapid test, such as the stable microbubble test (SMT) on gastric aspirate, may identify those who can be managed successfully using CPAP. Objective: To determine if SMT can identify soon after birth, very preterm infants who may be successfully managed on CPAP alone. Methods: Stable microbubbles (diameter <15 µm) were counted in gastric aspirates taken <1 h of age from infants <30 weeks' gestation, who received CPAP from birth. Infants failed CPAP if intubated at <72 h of age. Clinicians were masked to SMT results. A receiver operating characteristic curve was generated to determine the relationship between number of microbubbles/mm² and subsequent intubation. Results: 68 infants of mean (SD) 28.1 (1.4) weeks' gestation received CPAP in the delivery room at a median (interquartile range) pressure 7 (6-8) cmH₂O and FiO₂ 0.25 (0.21-0.3). Gastric aspirates were taken at a median (interquartile range) age of 0.5 (0.3-0.6) hours. The best cut-off point for predicting CPAP success or failure was a SMT count of 8 microbubbles/mm². The area under the receiver operating characteristic curve was 0.8 (95% CI 0.7-0.9). A SMT count ≥8 microbubbles/mm² had a sensitivity of 53%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 60% for predicting CPAP success. Conclusion: Infants treated with CPAP from birth, who hadSMT counts ≥8 microbubbles/mm² on their gastric aspirate, did not fail CPAP.

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Prediction of respiratory distress syndrome by the microbubble stability test on gastric aspirates in newborns of less than 32 weeks’gestation

Cited by 29 publications

References 23 publications

Implementation of surfactant treatment during continuous positive airway pressure

Implementation of surfactant treatment during continuous positive airway pressure

Oxygen requirement and surfactant therapy in preterm infants after delivery

The Stable Microbubble Test for Determining Continuous Positive Airway Pressure (CPAP) Success in Very Preterm Infants Receiving Nasal CPAP from Birth

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