Surfactant and Nasal-Cpap Before 30 Weeks of Gestation

Surfactant Administration via Thin Catheter During Spontaneous Breathing: Randomized Controlled Trial

“…3 Therefore, to combine the benefits of both principles, the so-called Intubate, Surfactant, Extubate (InSurE) method was developed. [4][5][6] However, surfactant instillation requires intubation and positive pressure ventilation (PPV) for its distribution, and even a short period of vigorous manual ventilation can induce significant lung injury. 7 There is an ongoing discussion on potential hazardous effects of even brief PPV and intubation that are required in the InSurE procedure.…”

“…Stabilization with nCPAP after birth and administration of rescue surfactant via intubation are the main characteristics of these relatively noninvasive approaches. In 1994, Verder et al 4 published the first randomized controlled trial of surfactant instillation during nCPAP, showing that a single dose of surfactant reduced the need for MV by half, from 85% to 43% and demonstrated that the effect was even more pronounced if surfactant was given as early rescue treatment 4,5. More recently, nCPAP and rescue intubation were studied in large cohorts of very preterm infants in Surfactant, Positive Pressure, and Oxygenation Randomized Trial (SUPPORT),30 Continuous Positive Airway Pressure or Intubation at Birth Trial (COIN),…”

Mental health of extremely low birth weight survivors: A systematic review and meta-analysis.

“…Between the 1960s and the 1980s, intensive care of preterm newborns was limited to intravenous fluid administration, assisted ventilation (by endotracheal intubation), and oxygen monitoring (Hack & Costello, 2008). The 1990s saw widespread adoption of surfactant to treat or prevent severe respiratory distress syndrome in preterm neonates, and prenatal administration of synthetic glucocorticoids, to maximally develop lung function in fetuses at risk (e.g., Ferrara et al, 1991;Göpel et al, 2015;Hoekstra, Ferrara, Couser, Payne, & Connett, 2004;Pelkonen, Hakulinen, Turpeinen, & Hallman, 1998;Verder et al, 1994). Concomitantly, survival of preterm infants increased during the 1990s in the United States (Fanaroff et al, 1995;Hoekstra et al, 2004), Britain (Riley, Roth, Sellwood, & Wyatt, 2008), and Australia, (Doyle, 2006;Doyle, & the Victorian Infant Collaborative Study Group, 2004).…”

Comparison of minimally invasive surfactant therapy with intubation surfactant administration and extubation for treating preterm infants with respiratory distress syndrome: a randomized clinical trial

“…In INtubation, SURfactant administration, and Extubation (INSURE), which is the most common method, the baby is first intubated and then extubated after surfactant administration. 3) However, sometimes tracheal intubation fails and causes hypoxia, bradycardia, increased intracranial pressure, and respiratory system injury. 4) Moreover, mechanical ventilation can cause barotrauma and lung injuries making the infant susceptible to chronic lung disease.…”