Treatment and outcome data of very low birth weight infants treated with less invasive surfactant administration in comparison to intubation and mechanical ventilation in the clinical setting of a cross-sectional observational multicenter study

Langhammer, Kristina; Roth, Bernhard; Kribs, Angela; Göpel, Wolfgang; Kuntz, Ludwig; Miedaner, Felix

doi:10.1007/s00431-018-3179-x

Cited by 25 publications

(26 citation statements)

References 31 publications

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“…Our study was able to define 36 days as a time of MV exposure that is associated with the development of moderate to severe BPD and, as a consequence, may have worse outcomes, such as greater severity of ROP and length of hospital stay. Therefore, it is suggested that MV should be avoided whenever possible, using strategies such as prophylactic CPAP and less invasive surfactant admnistration [26,27]. Moreover, MV should be interrupted as soon as possible, preferably before 36 days to reduce the risk of developing moderate to severe BPD, as well as to avoid impairments associated with the severity of the disease.…”

Section: Discussionmentioning

confidence: 99%

Influence of time under mechanical ventilation on bronchopulmonary dysplasia severity in extremely preterm infants: a pilot study

et al. 2020

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Background: The relation between mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD)-a common disease in extremely premature newborn (PTNB)-is well stabilished, but is unknown, however, how much time under MV influences the severity of the disease. Aim: To define the duration under MV with greater chance to develop moderate to severe BPD in extremely PTNB and to compare clinical outcomes before and during hospitalization among patients with mild and moderate to severe BPD. Methods: Fifty-three PTNB were separated into mild and moderate to severe BPD groups and their data were analyzed. Time under MV with a greater chance of developing moderate to severe BPD was estimated by the ROC curve. Perinatal and hospitalization outcomes were compared between groups. A logistic regression was performed to verify the influence of variables associated to moderate to severe BPD development, such as pulmonary hypertension (PH), gender, gestational age (GA) and weight at birth, as well the time under MV found with ROC curve. The result of ROC curve was validated using an independent sample (n = 16) by Chi-square test. Results: Time under MV related to a greater chance of developing moderate to severe BPD was 36 days. Moderate to severe BPD group had more males (14 vs 5, p = 0,047), longer time under MV (43 vs 19 days, p < 0,001), more individuals with PH (12 vs 3, p = 0,016), worse retinopathy of prematurity (grade 3, 2 vs 11, p = 0,003), longer hospital length of stay (109 vs 81,5 days, p < 0,001), greater PMA (41 vs 38 weeks, p < 0,001) and weight (2620 vs 2031 g, p < 0,001) at discharge and the mild BPD group had more CPAP use prior to MV (12 vs 7, p = 0,043). Among all variables included in logistic regression, only PH and MV < 36 days were significant in the model, explaining 72% of variation in moderate to severe BPD development. In the validation sample, prevalence of preterm infants who needed MV for more than 36 days in the moderate to severe BPD group was 100% (n = 6) and 0% in mild BPD group (p = 0,0001).

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Section: Discussionmentioning

confidence: 99%

Influence of time under mechanical ventilation on bronchopulmonary dysplasia severity in extremely preterm infants: a pilot study

et al. 2020

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“…Of these 15 studies, three used data from the German Neonatal Network, which reflects the actual clinical practice in more than 50 neonatal intensive care units across the country. 14,26,27 These studies used a matchedpair analysis in which each baby treated with the LISA technique was paired with a baby from a historic cohort, using similar significant characteristics, such as gestational age and Apgar scores. The studies presented in this review provide collective data from 4926 newborn infants who received surfactant by the LISA/SURE technique.…”

Section: Re Sultsmentioning

confidence: 99%

“…Most of the studies showed that LISA/SURE reduced the need for mechanical ventilation, ranging from 7.2% to 42% in treated infants. [14][15][16][17]22,[24][25][26][28][29][30][31][32]…”

Section: Main Outcomesmentioning

confidence: 99%

Systematic review found that using thin catheters to deliver surfactant to preterm neonates was associated with reduced bronchopulmonary dysplasia and mechanical ventilation

et al. 2020

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Aim: Surfactant delivery is a cornerstone for managing respiratory distress in preterm neonates, but data on the best surfactant delivery methods have been conflicting. Methods: A systematic literature review using the PubMed, Embase, Cochrane Library and Web of Science databases identified papers published up to November 5, 2019. Additional studies were identified from trial registries, conference proceedings and the reference lists of the selected papers. Results: We identified 15 studies covering 4926 preterm infants. The randomised controlled trials (RCTs) and observational studies both showed significant reductions in early intubation rates with use of thin catheters. The relative risk (RR) was 0.63 and the 95% confidence interval (95% CI) was 0.55-0.72 (P < .01), with an odds ratio (OR) of 0.40 and 95% CI of 0.35-0.45 (P < .0001). The collective results from the RCTs revealed a significant decrease in bronchopulmonary dysplasia (BPD) rates in the thin catheter group (RR, 0.47; 95% CI 0.33-0.66; P < .01). These findings were consistent with the observational studies (OR 0.47; 95% CI 0.43-0.52; P < .01). Conclusion: Using thin catheters to deliver surfactant in comparison with intubatesurfactant-extubate (INSURE) to newborn preterm infants with respiratory distress was associated with a reduced incidence of BPD and less need for mechanical ventilation.

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“…Unlike other reports where standard nasal CPAP was used with LISA [ 21 – 24 ], 63% of the procedures were carried out using BiPAP or NIPPV. While the potential advantages of BiPAP over CPAP remain uncertain, NIPPV proved to be more effective than nCPAP in reducing respiratory failure and the need for mechanical ventilation among preterm infants with RDS [ 7 , 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Implementation of less invasive surfactant administration in clinical practice—Experience of a mid-sized country

Szczapa

Hożejowski²,

Krajewski³

2020

PLoS ONE

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Treatment and outcome data of very low birth weight infants treated with less invasive surfactant administration in comparison to intubation and mechanical ventilation in the clinical setting of a cross-sectional observational multicenter study

Cited by 25 publications

References 31 publications

Influence of time under mechanical ventilation on bronchopulmonary dysplasia severity in extremely preterm infants: a pilot study

Influence of time under mechanical ventilation on bronchopulmonary dysplasia severity in extremely preterm infants: a pilot study

Systematic review found that using thin catheters to deliver surfactant to preterm neonates was associated with reduced bronchopulmonary dysplasia and mechanical ventilation

Implementation of less invasive surfactant administration in clinical practice—Experience of a mid-sized country

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