Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants

Rojas-Reyes, María Ximena; Morley, C J; Soll, Roger F.

doi:10.1002/14651858.cd000510.pub2

Cited by 373 publications

(242 citation statements)

References 45 publications

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“…With the increasing use of antenatal steroids and the routine use of NCPAP in the delivery room to establish functional residual capacity, use of prophylactic surfactant is no longer recommended. Prophylactic use of surfactant in infants at high risk of developing RDS does not lead to clinical improvement and may increase the risk of lung injury or death, when compared to early NCPAP and selective surfactant therapy [74]. Recently a synthetic surfactant, surfaxin, has been approved for prevention of RDS.…”

Section: Surfactant Therapymentioning

confidence: 99%

Non-Invasive Ventilation and Surfactant Therapy

Ramanathan

Paz²,

Biniwale³

2013

J Pulm Respir Med

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The lungs of premature infants are more vulnerable than term infants to the effects of invasive positive pressure ventilation. Published literature supporting the use of non-invasive respiratory support with CPAP, bi-level CPAP mode, such as, SiPAP and Nasal Intermittent Positive Pressure Ventilation (NIPPV), and surfactant administration strategies are discussed. This review focuses on non-invasive respiratory support strategies and selective early use of surfactant that may reduce the incidence of bronchopulmonary dysplasia. Invasive VentilationBronchopulmonary Dysplasia (BPD) remains major pulmonary morbidity in preterm infants with Respiratory Distress Syndrome (RDS), especially among the Extremely Low Birth Weight (ELBW) infants, [1] and is associated with short-and long-term adverse pulmonary and non-pulmonary outcomes. Advances in perinatal care, including antenatal corticosteroid use, advances in invasive mechanical ventilation modes, and postnatal surfactant therapy have significantly decreased the severity of RDS and neonatal mortality. Despite these changes, invasive ventilation via an endotracheal tube remains as one of the major reasons for the development of BPD. Prophylactic or rescue surfactant therapy alone has not been shown to decrease BPD rate. Noninvasive respiratory support modes, especially bilevel CPAP or SiPAP mode, have not been shown to impact BPD rate. However, use of early, rescue surfactant therapy and NIPPV mode has been shown to decrease BPD rate. This review will focus on the benefits of surfactant therapy used in combination with NIPPV mode of respiratory support in preterm infants.

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Section: Surfactant Therapymentioning

confidence: 99%

Non-Invasive Ventilation and Surfactant Therapy

Ramanathan

Paz²,

Biniwale³

2013

J Pulm Respir Med

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“…To date, a number of trials of SI but not PEEP recruitment at birth have been performed in humans (4,18,19). Surfactant is known to improve lung mechanics and oxygenation, and its benefits in preterm infants are well established (2). The lack of improvement in C dyn and AaDO 2 following surfactant administration in the SI groups was surprising.…”

Section: Discussionmentioning

confidence: 99%

“…The former was likely due to the environmental factors, as these ewes were mated at the end of a long drought. The protective benefit of surfactant and steroids is established (2,3) and the important question is whether a specific recruitment strategy altered injury within a particular epoch. We have previously reported this (6,11) and have not shown a difference in early biomarkers of lung injury.…”

Section: Discussionmentioning

confidence: 99%

“…Together, these therapies reduce the potential of assisted ventilation to injure the developmentally immature, surfactant-deficient preterm lung. The roles of early exogenous surfactant therapy (2) and antenatal corticosteroids (3) in improving lung mechanics, functional residual capacity, and reducing respiratory support are well established. The optimal respiratory support strategies are still debated (4-7).…”

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The interrelationship of recruitment maneuver at birth, antenatal steroids, and exogenous surfactant on compliance and oxygenation in preterm lambs

et al. 2016

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Background:To describe the interrelationship between antenatal steroids, exogenous surfactant, and two approaches to lung recruitment at birth on oxygenation and respiratory system compliance (C dyn ) in preterm lambs. Methods: Lambs (n = 63; gestational age 127 ± 1 d) received either surfactant at 10-min life (Surfactant), antenatal corticosteroids (Steroid), or neither (Control). Within each epoch lambs were randomly assigned to a 30-s 40 cmH 2 O sustained inflation (SI) or an initial stepwise positive end-expiratory pressure (PEEP) open lung ventilation (OLV) maneuver at birth. All lambs then received the same management for 60-min with alveolar-arterial oxygen difference (AaDO 2 ) and C dyn measured at regular time points. results: Overall, the OLV strategy improved C dyn and AaDO 2 (all epochs except Surfactant) compared to SI (all P < 0.05; twoway ANOVA). Irrespective of strategy, C dyn was better in the Steroid group in the first 10 min (all P < 0.05). Thereafter, C dyn was similar to Steroid epoch in the OLV + Surfactant, but not SI + Surfactant group. OLV influenced the effect of steroid and surfactant (P = 0.005) on AaDO 2 more than SI (P = 0.235). conclusions: The antenatal state of the lung influences the type and impact of a recruitment maneuver at birth. The effectiveness of surfactant maybe enhanced using PEEPbased time-dependent recruitment strategies rather than approaches solely aimed at initial lung liquid clearance.i t is widely agreed that the optimal support of the preterm lung involves the combination of antenatal corticosteroid exposure, exogenous surfactant therapy, and early application of lung protective respiratory support strategies (1). Together, these therapies reduce the potential of assisted ventilation to injure the developmentally immature, surfactant-deficient preterm lung. The roles of early exogenous surfactant therapy (2) and antenatal corticosteroids (3) in improving lung mechanics, functional residual capacity, and reducing respiratory support are well established. The optimal respiratory support strategies are still debated (4-7).Ideally, lung protective respiratory support should commence during transition to ex utero life (1,8). During this period, the infant must rapidly clear lung liquid, aerate the lung, establish a functional residual capacity, and commence tidal ventilation, processes influenced by the intrinsic mechanical properties of the lung as well as the applied respiratory strategy (5,6,9-13). The optimal approach in preterm infants remains unclear but broadly requires an inflating pressure to drive fetal lung fluid into the alveoli and allow lung aeration, and positive end-expiratory pressure (PEEP) to maintain aeration and prevent fluid efflux back into the airways (14-17). In preterm animals, using an initial stepwise PEEP or open lung ventilation (OLV) approach during tidal ventilation from birth improves aeration and short-term respiratory outcomes in preterm animals via utilizing hysteresis and time dependency (6,11). However, clinical trials at birth...

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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 versus selective use of surfactant in preventing morbidity and mortality in preterm infants

Cited by 373 publications

References 45 publications

Non-Invasive Ventilation and Surfactant Therapy

Non-Invasive Ventilation and Surfactant Therapy

The interrelationship of recruitment maneuver at birth, antenatal steroids, and exogenous surfactant on compliance and oxygenation in preterm lambs

Managing Children with Bronchopulmonary Dysplasia

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