Enhanced INSURE (ENSURE): an updated and standardised reference for surfactant administration

Background and Objectives: Retinopathy of prematurity (ROP) is the leading cause of blindness in preterm infants. We studied the relationship between different perinatal characteristics, i.e., sex; gestational age (GA); birth weight (BW); C-reactive protein (CRP) and lactate dehydrogenase (LDH) concentrations; ventilation, continuous positive airway pressure (CPAP), and surfactant administration; and the incidence of Stage 1–3 ROP. Materials and Methods: This study included 247 preterm infants with gestational age (GA) < 32 weeks that were successfully screened for ROP. Univariate and multivariate binary analyses were performed to find the most significant risk factors for ROP (Stage 1–3), while multivariate multinomial analysis was used to find the most significant risk factors for specific ROP stages, i.e., Stage 1, 2, and 3. Results: The incidence of ROP (Stage 1–3) was 66.40% (164 infants), while that of Stage 1, 2, and 3 ROP was 15.38% (38 infants), 27.53% (68 infants), and 23.48% (58 infants), respectively. Following univariate analysis, multiple perinatal characteristics, i.e., GA; BW; and ventilation, CPAP, and surfactant administration, were found to be statistically significant risk factors for ROP (p < 0.001). However, in a multivariate model using the same characteristics, only BW and ventilation were significant ROP predictors (p < 0.001 and p < 0.05, respectively). Multivariate multinomial analysis revealed that BW was only significantly correlated with Stage 2 and 3 ROP (p < 0.05 and p < 0.001, respectively), while ventilation was only significantly correlated with Stage 2 ROP (p < 0.05). Conclusions: The results indicate that GA; BW; and the use of ventilation, CPAP, and surfactant were all significant risk factors for ROP (Stage 1–3), but only BW and ventilation were significantly correlated with ROP and specific stages of the disease, namely Stage 2 and 3 ROP and Stage 2 ROP, respectively, in multivariate models.

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Cost-saving effect of early less invasive surfactant administration versus continuous positive airway pressure therapy alone for preterm infants with respiratory distress syndrome

European Journal of Hospital Pharmacy ◽

10.1136/ejhpharm-2020-002465 ◽

2021 ◽

pp. ejhpharm-2020-002465

Author(s):

Carlo Federici ◽

Giulia Fornaro ◽

Charles Christopher Roehr

Keyword(s):

Continuous Positive Airway Pressure ◽

Cost Saving ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Airway Pressure ◽

Distress Syndrome ◽

Positive Airway Pressure ◽

Pressure Therapy ◽

Surfactant Administration ◽

Saving Effect

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A Quality Improvement Initiative to Reduce Bronchopulmonary Dysplasia in a Level 4 NICU—Golden Hour Management of Respiratory Distress Syndrome in Preterm Newborns

Children ◽

10.3390/children8040301 ◽

2021 ◽

Vol 8 (4) ◽

pp. 301

Author(s):

Andrew M. Dylag ◽

Jamey Tulloch ◽

Karen E. Paul ◽

Jeffrey M. Meyers

Keyword(s):

Quality Improvement ◽

Lung Disease ◽

Chronic Lung Disease ◽

Control Charts ◽

Fluid Management ◽

Delivery Room ◽

Quality Improvement Initiative ◽

Statistical Process ◽

Golden Hour ◽

Surfactant Administration

Background: Prevention of chronic lung disease (CLD) requires a multidisciplinary approach spanning from the delivery room to Neonatal Intensive Care Unit (NICU) discharge. In 2018, a quality improvement (QI) initiative commenced in a level 4 NICU with the goal of decreasing chronic lung disease rates below the Vermont Oxford Network (VON) average of 24%. Methods: Improvement strategies focused on addressing the primary drivers of ventilation strategies, surfactant administration, non-invasive ventilation, medication use, and nutrition/fluid management. The primary outcome was VON CLD, defined as need for mechanical ventilation and/or supplemental oxygen use at 36 weeks postmenstrual age. Statistical process control charts were used to display and analyze data over time. Results: The overall CLD rate decreased from 33.5 to 16.5% following several interventions, a 51% reduction that has been sustained for >18 months. Changes most attributable to this include implementation of the “golden hour” gestational age (GA) based delivery room protocol that encourages early surfactant administration and timely extubation. Fewer infants were intubated across all GA groups with the largest improvement among infants 26–27 weeks GA. Conclusions: Our efforts significantly decreased CLD through GA-based respiratory guidelines and a comprehensive, rigorous QI approach that can be applicable to other teams focused on improvement.

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Examining Variations in Surfactant Administration (ENVISION): A Neonatology Insights Pilot Project

Children ◽

10.3390/children8040261 ◽

2021 ◽

Vol 8 (4) ◽

pp. 261

Author(s):

Priya Patel ◽

Andrew Houck ◽

Daniel Fuentes

Keyword(s):

Clinical Practice ◽

Nurse Practitioners ◽

Pilot Project ◽

The United States ◽

Institution Type ◽

Respiratory Therapists ◽

Respiratory Management ◽

Surfactant Administration ◽

Practice Variations ◽

Almost All

Variability in neonatal clinical practice is well recognized. Respiratory management involves interdisciplinary care and often is protocol driven. The most recent published guidelines for management of respiratory distress syndrome and surfactant administration were published in 2014 and may not reflect current clinical practice in the United States. The goal of this project was to better understand variability in surfactant administration through conduct of health care provider (HCP) interviews. Questions focused on known practice variations included: use of premedication, decisions to treat, technique of surfactant administration and use of guidelines. Data were analyzed for trends and results were communicated with participants. A total of 54 HCPs participated from June to September 2020. In almost all settings, neonatologists or nurse practitioners intubated the infant and respiratory therapists administered surfactant. The INSURE (INtubation-SURrfactant-Extubation) technique was practiced by 83% of participants. Premedication prior to intubation was used by 76% of HCPs. An FiO2 ≥ 30% was the most common threshold for surfactant administration (48%). In conclusion, clinical practice variations exist in respiratory management and surfactant administration and do not seem to be specific to NICU level or institution type. It is unknown what effects the variability in clinical practice might have on clinical outcomes.

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Minimally Invasive Surfactant Administration for the Treatment of Neonatal Respiratory Distress Syndrome: A Multicenter Randomized Study in China

Frontiers in Pediatrics ◽

10.3389/fped.2020.00182 ◽

2020 ◽

Vol 8 ◽

Author(s):

Tongyan Han ◽

Huiqiang Liu ◽

Hui Zhang ◽

Ming Guo ◽

Xuefeng Zhang ◽

...

Keyword(s):

Minimally Invasive ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Randomized Study ◽

Neonatal Respiratory Distress Syndrome ◽

Neonatal Respiratory Distress ◽

Surfactant Administration

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Safety of Surfactant Administration before Transport of Premature Infants

Air Medical Journal ◽

10.1016/j.amj.2010.04.001 ◽

2010 ◽

Vol 29 (4) ◽

pp. 170-177 ◽

Cited By ~ 4

Author(s):

Manoj Biniwale ◽

Monica Kleinman

Keyword(s):

Premature Infants ◽

Surfactant Administration

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Neonatal lung ultrasound and surfactant administration: a pragmatic, multicenter study

CHEST Journal ◽

10.1016/j.chest.2021.06.076 ◽

2021 ◽

Author(s):

Francesco Raimondi ◽

Fiorella Migliaro ◽

Iuri Corsini ◽

Fabio Meneghin ◽

Luca Pierri ◽

...

Keyword(s):

Multicenter Study ◽

Lung Ultrasound ◽

Neonatal Lung ◽

Surfactant Administration

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Exogenous Surfactant Therapy for Pediatric Patients with Acute Respiratory Distress Syndrome

Canadian Respiratory Journal ◽

10.1155/1997/903459 ◽

1997 ◽

Vol 4 (1) ◽

pp. 21-26 ◽

Cited By ~ 13

Author(s):

James F Lewis ◽

Jasvinder S Dhillon ◽

Ram N Singh ◽

Craig C Johnson ◽

Timothy C Frewen

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Pilot Study ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Pediatric Patients ◽

Distress Syndrome ◽

Exogenous Surfactant ◽

Lung Dysfunction ◽

Surfactant Administration ◽

Severe Lung

Exogenous surfactant administration is currently being tested in patients with the acute respiratory distress syndrome (ARDS). The results of the studies have varied because several factors may influence the host’s response to this therapy. This clinical pilot study was designed to evaluate the safety and efficacy of exogenous surfactant administration in pediatric patients with ARDS. Surfactant was administered to 13 patients with severe lung dysfunction, and eight of these patients experienced a significant improvement in oxygenation after the first dose of surfactant. In these patients the exogenous surfactant was administered within 48 h of the diagnosis of ARDS, whereas in the five patients who did not respond, surfactant was administered several days after the onset of ARDS. Responders also spent fewer days on a mechanical ventilator and less time in intensive care compared with nonresponders. Based on the results of this pilot study, a more appropriate multicentre clinical trial should be designed to evaluate this treatment strategy.

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