Vol 93, No 9 (2022)
Research paper
Published online: 2022-01-26
Respiratory distress syndrome in preterm infants: possible impact of surfactant application techniques
Abstract
Objectives: Prematurity is one of the most important issues in perinatology. The most frequent postnatal pathology connected with prematurity is respiratory distress syndrome (RDS) caused by surfactant deficiency due to lung immaturity. RDS is one of the most frequent causes of mortality and morbidity with short- and long-term consequences. The aim of the study was to compare the effectiveness of individual surfactant supply techniques in the treatment of respiratory disorders in premature infants.
Material and methods: In the period from the year 2009 to 2013, there were 198 very premature infants that received surfactant included to this retrospective study.
They were divided into three groups based on the surfactant application method:
- Premature newborns with substitute ventilation, with supply of surfactant through a traditional endotracheal tube — Average gestational age 26.6 weeks; Mean birth weight 911 g; Average Apgar score 4 in 1st minute, 6 in 5th minute.
- Premature newborns with exogenous surfactant supplementation — InSure method — Average gestational age 28.3 weeks; Average birth weight 1117 g; Mean Apgar score 6 in 1st minute, 7 in 5th minute.
- Premature newborns with exogenous surfactant supplementation — Less Invasive Surfactant Administration (LISA) method — Mean gestational age 29.9 weeks; Average birth weight 1444 g; Average Apgar score 7 in 1st minute, 8 in 5th minute.
Results: Noninvasive methods of respiratory support and minimally invasive surfactant administration (MISA) significantly reduced the incidence of severe RDS, compared to the traditional method.
Conclusions: Non-invasive methods of respiratory support and MISA like LISA and InSure methods were safe and effective in the treatment of RDS.
Keywords: neonatologycontinuous positive airway pressurespontaneous breathingsurfactantrespiratory distress syndrome
References
- Kribs A, Härtel C, Kattner E, et al. Surfactant without intubation in preterm infants with respiratory distress: first multi-center data. Klin Padiatr. 2010; 222(1): 13–17.
- Verder H, Robertson B, Greisen G, et al. Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. Danish-Swedish Multicenter Study Group. N Engl J Med. 1994; 331(16): 1051–1055.
- Krajewski P, Chudzik A, Strzałko-Głoskowska B, et al. Surfactant administration without intubation in preterm infants with respiratory distress syndrome--our experiences. J Matern Fetal Neonatal Med. 2015; 28(10): 1161–1164.
- Aguar M, Cernada M, Brugada M, et al. Minimally invasive surfactant therapy with a gastric tube is as effective as the intubation, surfactant, and extubation technique in preterm babies. Acta Paediatr. 2014; 103(6): e229–e233.
- Klebermass-Schrehof K, Wald M, Schwindt J, et al. Less invasive surfactant administration in extremely preterm infants: impact on mortality and morbidity. Neonatology. 2013; 103(4): 252–258.
- Isayama T, Iwami H, McDonald S, et al. Association of Noninvasive Ventilation Strategies With Mortality and Bronchopulmonary Dysplasia Among Preterm Infants: A Systematic Review and Meta-analysis. JAMA. 2016; 316(6): 611–624.
- Kanmaz HG, Erdeve O, Canpolat FE, et al. Surfactant administration via thin catheter during spontaneous breathing: randomized controlled trial. Pediatrics. 2013; 131(2): e502–e509.
- Dunn MS, Kaempf J, de Klerk A, et al. Vermont Oxford Network DRM Study Group. Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates. Pediatrics. 2011; 128(5): e1069–e1076.
- Morley CJ, Davis PG, Doyle LW, et al. COIN Trial Investigators. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med. 2008; 358(7): 700–708.
- Finer NN, Carlo WA, Walsh MC, et al. SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med. 2010; 362(21): 1970–1979.
- Dargaville PA, Aiyappan A, De Paoli AG, et al. Minimally-invasive surfactant therapy in preterm infants on continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed. 2013; 98(2): F122–F126.
- Sood BG, Cortez J, Kolli M, et al. Aerosolized surfactant in neonatal respiratory distress syndrome: Phase I study. Early Hum Dev. 2019; 134: 19–25.
- Trevisanuto D, Marchetto L. Minimally invasive approaches for surfactant administration. Acta Biomed. 2013; 84 Suppl 1: 28–31.
- More K, Sakhuja P, Shah PS. Minimally invasive surfactant administration in preterm infants: a meta-narrative review. JAMA Pediatr. 2014; 168(10): 901–908.
- Herting E, Härtel C, Göpel W. Less invasive surfactant administration (LISA): chances and limitations. Arch Dis Child Fetal Neonatal Ed. 2019; 104(6): F655–F659.
- Kribs A, Roll C, Göpel W, et al. NINSAPP Trial Investigators. Nonintubated Surfactant Application vs Conventional Therapy in Extremely Preterm Infants: A Randomized Clinical Trial. JAMA Pediatr. 2015; 169(8): 723–730.
- Göpel W, Kribs A, Ziegler A, et al. German Neonatal Network. Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. Lancet. 2011; 378(9803): 1627–1634.
- Aldana-Aguirre JC, Pinto M, Featherstone RM, et al. Less invasive surfactant administration versus intubation for surfactant delivery in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2017; 102(1): F17–F23.
- Borszewska-Kornacka MK, Gulczyńska E, Kostuch M, et al. Antenatal corticosteroids and respiratory distress syndrome - the first Polish national survey. Ginekol Pol. 2016; 87(7): 498–503.
- Herting E, Härtel C, Göpel W. Less invasive surfactant administration (LISA): chances and limitations. Arch Dis Child Fetal Neonatal Ed. 2019; 104(6): F655–F659.
- Herting E. Less invasive surfactant administration (LISA) - ways to deliver surfactant in spontaneously breathing infants. Early Hum Dev. 2013; 89(11): 875–880.
- Michna J, Jobe AH, Ikegami M. Positive end-expiratory pressure preserves surfactant function in preterm lambs. Am J Respir Crit Care Med. 1999; 160(2): 634–639.
- Stevens TP, Blennow M, Soll RF. Early surfactant administration with brief ventilation vs selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Syst Rev. 2004(3): CD003063.
