Journal of Research in Pharmacy Practice

Early administration of surfactant via a thin intratracheal catheter in preterm infants with respiratory distress syndrome: Feasibility and outcome

Document Type : Original Article

Authors

. Majid Mohammadizadeh
. Azam Ghehsareh Ardestani
. Ali Reza Sadeghnia

Department of Pediatrics, Child Health Promotion Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract
Objective: Currently, the method of early nasal continuous positive airway pressure 
(nCPAP) and selective administration of surfactant via an endotracheal tube is widely used 
in the treatment of respiratory distress syndrome (RDS) in premature infants. To prevent 
complications related to endotracheal intubation and even a brief period of mechanical 
ventilation, in this study, we compared the effectiveness of surfactant administration via a 
thin intratracheal catheter versus the current method using an endotracheal tube.
Methods: Thirty eight preterm infants ≤34 weeks’ gestation with birth weight of 1000–1800 g 
who were putted on nCPAP for RDS within the first hour of life, were randomly assigned 
to receive surfactant either via endotracheal tube (ET group) or via thin intratracheal 
catheter (CATH group). The primary outcomes were the need for mechanical ventilation 
and duration of oxygen therapy. Data were analyzed by independent t-test, Mann–Whitney 
U-test, and Chi-square test, using SPSS v. 21.
Findings: There was no significant difference between groups regarding to need for 
mechanical ventilation during the first 72 h of birth (3 [15.8%] in ET group vs. 2 [10.5%] in 
CATH group; P = 0.99). Duration of oxygen therapy in CATH group was significantly lower 
than ET group (243.7 ± 74.3 h vs. 476.8 ± 106.8 h, respectively; P = 0.018). The incidence of 
adverse events during all times of surfactant administration was not statistically significant 
between groups (P = 0.14), but the number of infants who experienced adverse events during 
surfactant administration was significantly lower in CATH group than ET group (6 [31.6%] vs. 
12 [63.2%], respectively; P = 0.049). All other outcomes, including duration of treatment with 
CPAP and mechanical ventilation, times of surfactant administration and the need for more 
than one dose of the drug, the rate of intraventricular hemorrhage, mortality and combined 
outcome of chronic lung disease or mortality were statistically similar between the groups
Conclusion: Surfactant administration via thin intratracheal catheter in preterm infants 
receiving nCPAP for treatment of RDS has similar efficacy, feasibility and safety to its 
administration via endotracheal tube.

Keywords

Endotracheal tube
preterm infants
respiratory distress syndrome
  surfactant
thin catheter
1. Kattwinkel J, Robinson M, Bloom BT, Delmore P, Ferguson JE. 
Technique for intrapartum administration of surfactant 
without requirement for an endotracheal tube. J Perinatol 
2004;24:360‑5.
2. Kribs A, Vierzig A, Hünseler C, Eifinger F, Welzing L, 
Stützer H, et al. Early surfactant in spontaneously breathing 
with nCPAP in ELBW infants – a single centre four year 
experience. Acta Paediatr 2008;97:293-8.
3. Support Study Group of the Eunice Kennedy Shriver NICHD 
Neonatal Research Network, Finer NN, Carlo WA, Walsh MC, 
Rich W, Gantz MG, et al. Early CPAP versus surfactant in 
extremely preterm infants. N Engl J Med 2010;362:1970-9.
4. Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, 
Carlin JB, et al. Nasal CPAP or intubation at birth for very 
preterm infants. N Engl J Med 2008;358:700‑8.
5. Stevens TP, Sinkin RA. Surfactant replacement therapy. Chest 
2007;131:1577‑82.
6. Shah S. Exogenous surfactant: Intubated present, nebulized 
future? World J Pediatr 2011;7:11‑5.
7. Attridge JT, Stewart C, Stukenborg GJ, Kattwinkel J. 
Administration of rescue surfactant by laryngeal mask airway: 
Lessons from a pilot trial. Am J Perinatol 2013;30:201-6.
8. Abdel‑Latif ME, Osborn DA. Pharyngeal instillation of 
surfactant before the first breath for prevention of morbidity 
and mortality in preterm infants at risk of respiratory distress 
syndrome. Cochrane Database Syst Rev 2011;(3):CD008311.
9. Kribs A, Pillekamp F, Hünseler C, Vierzig A, Roth B. Early 
administration of surfactant in spontaneous breathing with 
nCPAP: Feasibility and outcome in extremely premature 
infants (postmenstrual age </=27 weeks). Paediatr Anaesth 
2007;17:364-9.
10. Kribs A, Härtel C, Kattner E, Vochem M, Küster H, Möller J, 
et al. Surfactant without intubation in preterm infants with 
respiratory distress: First multi‑center data. Klin Padiatr 
2010;222:13-7.
11. Mehler K, Grimme J, Abele J, Huenseler C, Roth B, Kribs A. 
Outcome of extremely low gestational age newborns after 
introduction of a revised protocol to assist preterm infants in 
their transition to extrauterine life. Acta Paediatr 2012;101:1232-9.
12. Dargaville PA, Aiyappan A, De Paoli AG, Kuschel CA, 
Kamlin CO, Carlin JB, et al. Minimally-invasive surfactant 
therapy in preterm infants on continuous positive airway 
pressure. Arch Dis Child Fetal Neonatal Ed 2013;98:F122‑6.
13. Dargaville PA. Innovation in surfactant therapy I: Surfactant 
lavage and surfactant administration by fluid bolus using 
minimally invasive techniques. Neonatology 2012;101:326-36.
14. Göpel W, Kribs A, Ziegler A, Laux R, Hoehn T, Wieg C, et al.
Avoidance of mechanical ventilation by surfactant treatment of 
spontaneously breathing preterm infants (AMV): An open-label, 
randomised, controlled trial. Lancet 2011;378:1627-34.
15. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, 
Plavka R, et al. European consensus guidelines on the 
management of neonatal respiratory distress syndrome in 
preterm infants-2010 update. Neonatology 2010;97:402-17.
Journal of Research in Pharmacy Practice
Volume 4, Issue 1
Winter 2015
Pages 31-36

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