Document Type : Original Article
Authors
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
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.
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