Prophylactic or Early Selective Surfactant Combined With nCPAP in Very Preterm Infants

Sandri, Fabrizio; Plavka, R; Ancora, Gina; Simeoni, Umberto; Straňák, Z; Martinelli, Stefano; Mosca, Fabio; Nona, José; Thomson, M.; Verder, Henrik; Fabbri, L.; Halliday, Henry L.

doi:10.1542/peds.2009-2131

Cited by 321 publications

(225 citation statements)

References 25 publications

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“…21,25 Previous studies using NCPAP as a primary mode of respiratory support or following extubation reported failures requiring intubation or reintubation. [9][10][11][12][13][14][15][16]29 These investigators used different types of nasal interfaces, such as single versus binasal prongs and different CPAP generators like bubble CPAP, infant flow drivers and conventional mechanical ventilators. CPAP failure rates by 3 to 7 days ranged from 19.7 to 80% in these studies.…”

Section: Discussionmentioning

confidence: 99%

“…8 However, several studies have shown that a significant number of infants treated with NCPAP alone or following extubation from MVET fail NCPAP and require reintubation. [9][10][11][12][13][14][15] Furthermore, two recent large trials 11,15 evaluating the effects of early NCPAP did not show a decrease in BPD. The most common reasons for extubation failure are recurrent apnea, bradycardia or desaturations, and or development of respiratory acidosis.…”

Section: Introductionmentioning

confidence: 99%

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Nasal intermittent positive pressure ventilation after surfactant treatment for respiratory distress syndrome in preterm infants <30 weeks’ gestation: a randomized, controlled trial

et al. 2012

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Objective: To compare the effect of early extubation to nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) on the need for mechanical ventilation via endotracheal tube (MVET) at 7 days of age in preterm infants <30 weeks' gestation requiring intubation and surfactant for respiratory distress syndrome (RDS) within 60 min of delivery.Study Design: Multicenter, randomized, controlled trial. A total of 57 infants were randomized within 120 min of birth to NCPAP (BW 1099 g and GA 27.8 weeks) and 53 infants to NIPPV (BW 1052 g, and GA 27.8 weeks). Infants were stabilized on NCPAP at birth and were given poractant alfa combined with MVET within 60 min of age. When stabilized on MVET, they were extubated within the next hours or days to NCPAP or NIPPV.Result: A total of 40% of infants needed MVET at 7 days of age in the NCPAP group compared with 17% in the NIPPV group (OR: 3.6; 95% CI: 1.5, 8.7). Days on MVET were 12±11 days in NCPAP group compared with 7.5 ± 12 days in the NIPPV group (median 1 vs 7 days; P ¼ 0.006). Clinical bronchopulmonary dysplasia (BPD) was 39% in the NCPAP group compared to 21% in the NIPPV group (OR: 2.4; 95% CI: 1.02, 5.6). Physiological BPD was 46% in the NCPAP group compared with 11% in the NIPPV group (OR: 6.6, 95% CI: 2.4, 17.8; P ¼ 0.001). There were no differences in any other outcomes between the two groups. Keywords: respiratory distress syndrome; surfactant; preterm; bronchopulmonary dysplasia; NIPPV; NCPAP Introduction Respiratory distress syndrome (RDS) is the most common respiratory morbidity in preterm infants. Surfactant therapy and mechanical ventilation have become the standard of care in preterm infants with RDS. Bronchopulmonary dysplasia (BPD) continues to remain a major morbidity among preterm very low birth weight infants despite the increasing use of antenatal steroids, surfactant therapy and significant advances in mechanical ventilation. 1-3 BPD is associated with both short-and long-term morbidities in very low birth weight infants. Factors associated with BPD include prolonged intubation, mechanical ventilation, barotrauma, volutrauma or oxygen-induced lung inflammation. 4 Early surfactant administration followed by extubation to nasal continuous positive airway pressure (NCPAP) or NCPAP alone without surfactant therapy have been shown to decrease the incidence of BPD in very low birth weight infants in observational studies. 5,6 Findings of a multicenter randomized controlled trial 7 investigating whether early versus late treatment with surfactant reduced the requirement of mechanical ventilation in very preterm infants primarily supported by NCPAP found that early surfactant treatment improved oxygenation 6 h after randomization and reduced the need for mechanical ventilation via endotracheal tube (MVET) before discharge from 68 to 25%. In addition, early surfactant administration followed by extubation to NCPAP in infants <30 weeks gestational age significantly decreased the need for MVET to 0% by 7 day...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nasal intermittent positive pressure ventilation after surfactant treatment for respiratory distress syndrome in preterm infants <30 weeks’ gestation: a randomized, controlled trial

et al. 2012

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“…En otros estudios no se han encontrado diferencias en la incidencia de la displasia broncopulmonar, pero en ninguno de ellos se empleó la misma intervención evaluada en el presente estudio. En el estudio COIN, por ejemplo, se evaluaron 610 neonatos de 25 a 28 semanas asignados a CPAP o respiración mecánica asistida, pero sin administración de surfactante, y se halló que la gravedad de la displasia era menor en el grupo tratado con CPAP; en el estudio IFDAS, cuyo diseño fue similar al del COIN, no se encontraron diferencias en la duración del soporte respiratorio requerido ni en la incidencia de displasia a los 28 días de edad extrauterina o a las 36 semanas de edad de gestación corregida; en el estudio SUPPORT se evaluaron prematuros atendidos con CPAP sin surfactante y con respiración mecánica asistida y surfactante administrado tempranamente, y no se encontraron diferencias en la incidencia de la displasia pero sí en su gravedad (24,34). Ahora bien, los hallazgos de estos estudios no deben arrojar dudas sobre el hecho de que está ampliamente comprobado que el surfactante juega un papel crucial en la resolución de la dificultad respiratoria.…”

Section: Discussionunclassified

Nasal CPAP vs. mechanical ventilation in 28-32 weeks preterm infants with early surfactant administration

et al. 2014

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“…Тактика раннего нача-ла СРАР и селективного введения сурфактанта более эффективна, чем рутинное проведение профилактики у детей, поскольку снижает необходимость интубации, а также риск смертельного исхода и/или развития БЛД [21][22][23].…”

Section: терапия и профилактикаunclassified

Managing Children with Bronchopulmonary Dysplasia

et al. 2016

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Bronchopulmonary dysplasia is one of the most significant early childhood chronic respiratory diseases. The article features modern approaches to preventing, diagnosing and treating broncho-pulmonary dysplasia, as well as ways of preventing complications and undesirable disease outcomes in patients older than 3 years. Members of professional associations — Union of Pediatricians of Russia and Russian Association of Perinatal Medicine Specialists — have summarized the experience of managing this category of patients at leading Russian pediatric centers according to the principles of evidence-based medicine and have provided scientific and practical data corresponding to the world level of knowledge with regard to the present problem.

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Prophylactic or Early Selective Surfactant Combined With nCPAP in Very Preterm Infants

Abstract: Prophylactic surfactant was not superior to nCPAP and early selective surfactant in decreasing the need for MV in the first 5 days of life and the incidence of main morbidities of prematurity in spontaneously breathing very preterm infants on nCPAP.

Cited by 321 publications

References 25 publications

Nasal intermittent positive pressure ventilation after surfactant treatment for respiratory distress syndrome in preterm infants <30 weeks’ gestation: a randomized, controlled trial

Nasal intermittent positive pressure ventilation after surfactant treatment for respiratory distress syndrome in preterm infants <30 weeks’ gestation: a randomized, controlled trial

Nasal CPAP vs. mechanical ventilation in 28-32 weeks preterm infants with early surfactant administration

Managing Children with Bronchopulmonary Dysplasia

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