Surfactant replacement therapy in neonates less than 32 weeks gestation: Effect on neonatal intensive care resource utilization

During the past decade, significant advances in the treatment of neonatal respiratory distress syndrome (RDS) have been directly attributable to the emergence of surfactant replacement therapy. Using a variety of surfactant preparations, clinical trials have been accomplished in a number of centers on large numbers of infants. These clinical trials showed that there were applications of surfactant replacement both in the prevention mode, early in life, and in the rescue mode, once RDS is diagnosed. There were no evident adverse effects on the infants, and there was significant reduction in mortality and severity of disease in the treated infants. Currently, a large number of neonatal intensive care units are enrolling infants in treatment investigational drug (IND) protocols as defined by the Food and Drug Administration (FDA) while the new drug applications are pending. Surfactant replacement therapy has numerous implications for neonatal nurses and will be part of all neonatal nursing skills in the near future

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Surfactant Replacement Therapy: Prophylaxis or Treatment?

PEDIATRICS ◽

10.1542/peds.92.1.148 ◽

1993 ◽

Vol 92 (1) ◽

pp. 148-150

Author(s):

MICHAEL S. DUNN

Keyword(s):

Replacement Therapy ◽

Neonatal Intensive Care ◽

Neonatal Intensive Care Units ◽

Delivery Method ◽

Premature Neonates ◽

Future Studies ◽

Surfactant Replacement ◽

Surfactant Replacement Therapy ◽

Considerable Controversy

After extensive preclinical and clinical testing, surfactant replacement therapy for premature neonates has become routine in modern neonatal intensive care units. Even though "everyone's doing it," there is nevertheless wide variation in how this therapy is applied. Future studies will be needed to help sort out some of the unresolved issues such as the best preparation, optimal delivery method, how best to ventilate the surfactant-treated neonate, when to retreat with surfactant, and the role of adjunctive therapies such as indomethacin or corticosteroids. Considerable controversy also exists over when surfactant should be administered. This issue has been studied in some depth, both in animals and premature neonates.

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Surfactant Utilization Evaluation in a Major Teaching Hospital in West of Iran: An Observational, Prospective Study

Journal of Pharmaceutical Care ◽

10.18502/jpc.v9i4.8221 ◽

2022 ◽

Author(s):

Sajad Khiali ◽

Mohammadbagher Hosseini ◽

Elnaz Shaseb

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Replacement Therapy ◽

Teaching Hospital ◽

Neonatal Intensive Care ◽

Distress Syndrome ◽

Standard Dose ◽

Surfactant Replacement ◽

Surfactant Replacement Therapy ◽

Clinical Records

Background: The respiratory distress syndrome (RDS) is a common pulmonary disorder that usually occurs as a result of preterm labor and is associated with lack of surfactant. The aim of this study was to evaluate the pattern of surfactant prescription in Alzahra teaching hospital in Tabriz, Iran. Methods: This drug use evaluation (DUE) study was conducted in the neonatal intensive care unit (NICU) of Al-Zahra Hospital, Tabriz, Iran. The demographic and clinical data collection was performed using clinical records of patients. The pattern of surfactant replacement therapy was evaluated and compared with the European Consensus Guideline on the management of respiratory distress syndrome in 2016. Results: A total of 252 premature infants who received surfactant between August 2017 and March 2018 were included. 80.8% of neonates were born by cesarean section. The most used surfactant was Curosurf®, which was used in 82.1% of cases. Only 34.9% of the infants received within 8 hours of birth. Moreover, 79% of infants received the standard dose of surfactant, while 9.5 % and 11.5% were given high and low doses of surfactant, respectively. Conclusion: The pattern of surfactant replacement therapy was not completely according to the guidelines, particularly regarding the time of administration. Considering the importance of dose and timely administration of surfactant, providing strategies to decrease these errors are important.

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Surfactant Replacement Therapy

10.1007/978-3-642-73305-5 ◽

1988 ◽

Cited By ~ 3

Keyword(s):

Replacement Therapy ◽

Surfactant Replacement ◽

Surfactant Replacement Therapy

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Veno-venous ECMO as a platform to evaluate lung lavage and surfactant replacement therapy in an animal model of severe ARDS

Intensive Care Medicine Experimental ◽

10.1186/s40635-020-00352-w ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Robert Qaqish ◽

Yui Watanabe ◽

Marcos Galasso ◽

Cara Summers ◽

A adil Ali ◽

...

Keyword(s):

Replacement Therapy ◽

Lung Lavage ◽

Post Injury ◽

Surfactant Replacement ◽

Recruitment Maneuvers ◽

Surfactant Replacement Therapy ◽

Dosing Strategies ◽

Yorkshire Pigs ◽

Saline Lavage ◽

Protective Systems

Abstract Background There are limited therapeutic options directed at the underlying pathological processes in acute respiratory distress syndrome (ARDS). Experimental therapeutic strategies have targeted the protective systems that become deranged in ARDS such as surfactant. Although results of surfactant replacement therapy (SRT) in ARDS have been mixed, questions remain incompletely answered regarding timing and dosing strategies of surfactant. Furthermore, there are only few truly clinically relevant ARDS models in the literature. The primary aim of our study was to create a clinically relevant, reproducible model of severe ARDS requiring extracorporeal membrane oxygenation (ECMO). Secondly, we sought to use this model as a platform to evaluate a bronchoscopic intervention that involved saline lavage and SRT. Methods Yorkshire pigs were tracheostomized and cannulated for veno-venous ECMO support, then subsequently given lung injury using gastric juice via bronchoscopy. Animals were randomized post-injury to either receive bronchoscopic saline lavage combined with SRT and recruitment maneuvers (treatment, n = 5) or recruitment maneuvers alone (control, n = 5) during ECMO. Results PaO2/FiO2 after aspiration injury was 62.6 ± 8 mmHg and 60.9 ± 9.6 mmHg in the control and treatment group, respectively (p = 0.95) satisfying criteria for severe ARDS. ECMO reversed the severe hypoxemia. After treatment with saline lavage and SRT during ECMO, lung physiologic and hemodynamic parameters were not significantly different between treatment and controls. Conclusions A clinically relevant severe ARDS pig model requiring ECMO was established. Bronchoscopic saline lavage and SRT during ECMO did not provide a significant physiologic benefit compared to controls.

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