Preliminary evaluation of a new technique of minimally invasive surfactant therapy

Dargaville, Peter A.; Aiyappan, Ajit; Cornelius, Anita; Williams, Christopher; De Paoli, Antonio G.
July 2011
Archives of Disease in Childhood -- Fetal & Neonatal Edition;Jul2011, Vol. 96 Issue 7, pF243
Academic Journal
Objective To investigate a method of minimally invasive surfactant therapy (MIST) to be used in spontaneously breathing preterm infants on continuous positive airway pressure (CPAP), evaluating the feasibility of the technique and the therapeutic benefit after MIST. Design Non-randomised feasibility study. Setting Tertiary neonatal intensive care unit. Patients and interventions Study subjects were preterm infants with respiratory distress supported with CPAP, with early enrolment of 25-28-week infants (n=11) at any CPAP pressure and fractional inspired O2 concentration (FiO2), and enrolment of 29-34-week infants (n=14) at CPAP pressure ≥7 cm H2O and FiO2 ≥0.35. Without premedication, a 16 gauge vascular catheter was inserted through the vocal cords under direct vision. Porcine surfactant (∼100 mg/kg) was then instilled, followed by reinstitution of CPAP. Measurements and results Respiratory indices were documented for 4 h following MIST, and neonatal outcomes ascertained. In all cases, surfactant was successfully administered and CPAP re-established. Coughing (32%) and bradycardia (44%) were transiently noted, and 44% received positive pressure inflations. There was a clear surfactant effect, with lower FiO2 after MIST (pre-MIST: 0.39±0.092 (mean±SD); 4 h: 0.26±0.093; p<0.01), and a modest reduction in CPAP pressure. Adverse outcomes were few: intubation within 72 h (n=3), pneumothorax (n=1), chronic lung disease (n=3) and death (n=1), all in the 25-28-week group. Outcome was otherwise favourable in both gestation groups, with a trend towards reduction in intubation in the first 72 h in the 25-28-week infants compared with historical controls. Conclusions Surfactant can be effectively delivered via a vascular catheter, and this method of MIST deserves further investigation.


Related Articles

  • The Role of Surfactant in Respiratory Distress Syndrome. Cheng-Hwa Ma, Christopher; Sze Ma // Open Respiratory Medicine Journal;2012, Vol. 6, p44 

    The key feature of respiratory distress syndrome (RDS) is the insufficient production of surfactant in the lungs of preterm infants. As a result, researchers have looked into the possibility of surfactant replacement therapy as a means of preventing and treating RDS. We sought to identify the...

  • Comparing the Effectiveness of Nasal Continuous Positive Airway Pressure (NCPAP) and High Flow Nasal Cannula (HFNC) in Prevention of Post Extubation Assisted Ventilation. Mostafa-Gharehbaghi, Manizheh; Mojabi, Hooshyar // Zahedan Journal of Research in Medical Sciences;Jun2015, Vol. 17 Issue 6, p1 

    Background: There is a growing trend toward avoidance of intubation and mechanical ventilation for preterm neonates. Noninvasive ventilation can be provided by a variety of ways including nasal cannula. Objectives: This study was conducted to compare the efficacy and safety of Humidified high...

  • Control system for continuous positive airway pressure. Oliveira, Mileny Ximenes; dos Reis Capistrano, Amilton; de Siqueira Rodrigues Fleury Rosa, Suélia; Silva, José Felício; da Rocha, Adson Ferreira; Carvalho, Hervaldo Sampaio // Revista Brasileira de Engenharia Biomédica;Jun2014, Vol. 30 Issue 2, p102 

    Introduction: Continuous Positive Airway Pressure (CPAP) is a mode of non-invasive mechanical ventilation commonly used in neonatology. The incorporation of new therapeutic and technological advances may impact the survival of very low birth weight preterm infants. However, one of the...

  • INSTALAÇÃO DO CPAP NASAL - IDENTIFICANDO A DOR DO RECÉM-NATO COMO UM CUIDADO DE ENFERMAGEM. Antunes, Joice Cristina Pereira; Nascimento, Maria Aparecida de Luca; de Oliveira Gomes, Aline Verônica; Araujo, Marcelle Campos // Journal of Nursing UFPE / Revista de Enfermagem UFPE;1/1/2010, Vol. 4 Issue 1, p137 

    Objectives: to identify whether nurses recognize the completion of the technical procedure of installation of nasal CPAP in newborns and trigger the pain, and to propose, from the results obtained, the insertion of this technique, the list of procedures painful. Methods: this is a descriptive,...

  • CPAP may be better than intubation and surfactant for oxygen delivery. Sanchez, Pablo // Infectious Diseases in Children;Jul2010, Vol. 23 Issue 7, p49 

    The article deals with a study about continuous positive airway pressure (CPAP) as an alternative to intubation or sufactant for delivering oxygen to preterm infants by Dr. Pablo Sanchez, published in an issue of "New England Journal of Medicine."

  • Is Sustained Lung Inflation a Good Idea for Preemies?  // AARC Times;May2015, Vol. 39 Issue 5, p60 

    The article discusses a study that investigated the effectiveness of providing sustained lung inflation and contiunous positive airway pressure (CPAP) in preterm infants right after birth for outcome improvement as published in "Pediatrics".

  • Highlights from this issue. Stenson, Ben // Archives of Disease in Childhood -- Fetal & Neonatal Edition;Jul2011, Vol. 96 Issue 7, pF235 

    An introduction is presented in which the editor discusses various studies within the issue on topics including the measurement of tidal volume and airway pressures, the use of continuous positive airway pressure (CPAP) as primary respiratory support, and the physiological effects of blood...

  • Assessment of surfactant use in preterm infants as a marker of neonatal intensive care unit quality. Kaplan, Heather C.; Lorch, Scott A.; Pinto-Martin, Jennifer; Putt, Mary; Silber, Jeffrey H. // BMC Health Services Research;2011, Vol. 11 Issue 1, p22 

    Background: Proposed neonatal quality measures have included structural measures such as average daily census, and outcome measures such as mortality and rates of complications of prematurity. However, process measures have remained largely unexamined. The objective of this research was to...

  • Management of Neonatal Apnea. Deakins, Kathleen // AARC Times;Nov2011, Vol. 35 Issue 11, p5 

    The article focuses on the management of neonatal apnea including apnea of maturity (AOP) in premature infants. It discusses its causes such as following maternal medications using magnesium sulfate, prostaglandins, or general anesthetics. It explores its prevalence in 24-26 weeks infants and...


Read the Article


Sign out of this library

Other Topics