Surfactant replacement therapy with a minimally invasive technique: Experience in a tertiary hospital

Candela, Fernando; Dı́az, Carlos; Robles, Mercedes; Gomis, Consuelo Vázquez; Durá, J. L. Quiles

doi:10.1016/j.anpede.2015.10.012

Cited by 5 publications

(2 citation statements)

References 13 publications

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“…We compared safety and efficacy of MIST and INSURE in <34 weeks neonate. The age of neonates described in many previous studies 9,15,16 was usually within six hours whereas we observed higher mean age in both groups which is mainly because that this trial was performed in a referral center where about 50% of patients presented after six hours of life.…”

Section: Discussioncontrasting

confidence: 48%

“…While soft catheters are used in LISA that require help of Magill forceps in addition to laryngoscope for insertion of catheter in trachea when compared with INSURE, MIST has fewer complications including the rate of intubation mortality, PDA, and pneumothorax. [12][13][14][15] On the other hand, more time is consumed in MIST technique 14 than INSURE and there are also risks of laryngoscopy associated complications. Previously, some trials favouring MIST had certain limitations for example small sample size and sedation during the procedure.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of surfactant administration by MIST and INSURE techniques in Neonates with Respiratory Distress Syndrome: A randomized controlled trial

Kaleem

Haroon²,

Fatima³

et al. 2023

Pak J Med Sci

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Objective: To measure the efficacy and safety of surfactant administered by MIST and INSURE to neonates with respiratory distress syndrome. Methods: A randomized controlled trial was conducted from June 2021 to August 2022 at the NICU of the University of Child Health Sciences, Lahore. Neonates meeting inclusion criteria i.e with RDS who worsened on nasal Continuous positive airway pressure (nCPAP) (fiO2 30%, pressure 6cmH2O) were enrolled in the study in both interventional arms (MIST, n=36 and INSURE, n=36) using simple random sampling. Data was analysed using SPSS 25. Results: The mean age of neonates in MIST was 1.27±0.40 days and 1.23±0.48 days in INSURE cohort. Neonates with MIST (n=8) required statistically significant reduced need for IMV than INSURE (n=17) technique (P-Value 0.047). This study could not achieve significant difference in duration of mechanical ventilation (1±1.67; 1.52±1.40 days, P=0.152) and duration of nCPAP (3.27±1.65;3.67±1.64 hrs, P=0.312) in MIST versus INSURE. The second dose of surfactant was administered in fewer cases in MIST (n=2) than INSURE (n=7) (P=0.075). Risk estimation, although not significant, determined less likelihood for the pulmonary haemorrhage (0.908 than 1.095), intraventricular hemorrhage (0.657 than 1.353), administration of the second dose of surfactant (0.412 than 1.690) and greater likelihood of discharge (1.082 than 0.270) at 95% confidence interval with MIST technique. Conclusion: Surfactant therapy through MIST is effective and there is significantly reduced need of IMV than in INSURE. Safety profile though could not achieve statistical significance yet determines less risk of complications associated with MIST than INSURE. doi: https://doi.org/10.12669/pjms.39.3.7283 How to cite this: Kaleem A, Haroon F, Fatima B, Victor G, Qadir M, Waheed KAI. Efficacy and safety of surfactant administration by MIST and INSURE techniques in Neonates with Respiratory Distress Syndrome: A randomized controlled trial. Pak J Med Sci. 2023;39(3):848-852. doi: https://doi.org/10.12669/pjms.39.3.7283 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussioncontrasting

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of surfactant administration by MIST and INSURE techniques in Neonates with Respiratory Distress Syndrome: A randomized controlled trial

Kaleem

Haroon²,

Fatima³

et al. 2023

Pak J Med Sci

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Update of minimally invasive surfactant therapy

Shim

2017

Korean J Pediatr

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To date, preterm infants with respiratory distress syndrome (RDS) after birth have been managed with a combination of endotracheal intubation, surfactant instillation, and mechanical ventilation. It is now recognized that noninvasive ventilation (NIV) such as nasal continuous positive airway pressure (CPAP) in preterm infants is a reasonable alternative to elective intubation after birth. Recently, a meta-analysis of large controlled trials comparing conventional methods and nasal CPAP suggested that CPAP decreased the risk of the combined outcome of bronchopulmonary dysplasia or death. Since then, the use of NIV as primary therapy for preterm infants has increased, but when and how to give exogenous surfactant remains unclear. Overcoming this problem, minimally invasive surfactant therapy (MIST) allows spontaneously breathing neonates to remain on CPAP in the first week after birth. MIST has included administration of exogenous surfactant by intrapharyngeal instillation, nebulization, a laryngeal mask, and a thin catheter. In recent clinical trials, surfactant delivery via a thin catheter was found to reduce the need for subsequent endotracheal intubation and mechanical ventilation, and improves short-term respiratory outcomes. There is also growing evidence for MIST as an alternative to the INSURE (intubation-surfactant-extubation) procedure in spontaneously breathing preterm infants with RDS. In conclusion, MIST is gentle, safe, feasible, and effective in preterm infants, and is widely used for surfactant administration with noninvasive respiratory support by neonatologists. However, further studies are needed to resolve uncertainties in the MIST method, including infant selection, optimal surfactant dosage and administration method, and need for sedation.

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Pulling out a broken catheter using interventional radiology in a preterm. Neonatal intensive care

et al. 2021

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There are different indications for the placement of a pleural drainage. It is indicated in a massive pneumothorax or a pleural effusion, and a tunnelled indwelling pleural catheter is put in place. As in any procedure, complications may occur. A broken catheter is a rare one, and when it occurs, it has to be removed by thoracoscopic surgery. This article describes the first case of a removal of a fractured pleural catheter in a preterm newborn with a bilateral pneumothorax using interventional radiology. We propose an alternative way less invasive that could enable a shorter recovery time with fewer complications.

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Surfactant replacement therapy with a minimally invasive technique: Experience in a tertiary hospital

Cited by 5 publications

References 13 publications

Efficacy and safety of surfactant administration by MIST and INSURE techniques in Neonates with Respiratory Distress Syndrome: A randomized controlled trial

Efficacy and safety of surfactant administration by MIST and INSURE techniques in Neonates with Respiratory Distress Syndrome: A randomized controlled trial

Update of minimally invasive surfactant therapy

Pulling out a broken catheter using interventional radiology in a preterm. Neonatal intensive care

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