scholarly journals 1154 The impact of less invasive surfactant administration on the need for mechanical ventilation in preterm infants <31 weeks gestation

2021 ◽  
Author(s):  
Kimberley Jefferies
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Less Invasive ◽  
Surfactant Administration ◽  
The Impact

Comparison Between Less Invasive Surfactant Administration (LISA) and Intubation-Surfactant-Extubation (InSurE) in Preterm Infants with Respiratory Distress Syndrome: A Retrospective Study

2020 ◽  
Author(s):  
Sungmin Yang ◽  
Yong Hyuk Kim ◽  
Byoung Kook Lee
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Study ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Distress Syndrome ◽  
Saturation Index ◽  
Invasive Mechanical Ventilation ◽  
Less Invasive ◽  
Surfactant Administration

Abstract Background: Bronchopulmonary dysplasia (BPD) is an important morbidity caused by neonatal lung injury due to mechanical ventilator use. Respiratory distress syndrome (RDS) is leading cause of mechanical ventilation in preterm infants. Surfactant was administrated through the endotracheal tube for management of RDS, which compels invasive mechanical ventilation. Recently, Intubation-SURfactant administration-Extubation (INSURE) and Less-invasive surfactant administration (LISA) have been introduced to avoid invasive mechanical ventilation. This study aimed to compare the effectiveness of LISA and INSURE.Methods: This single-center, retrospective study enrolled 47 newborns admitted to the neonatal intensive care unit (NICU) of the Wonju Severance Christian’s Hospital between January 1, 2017 and August 31, 2019, above a gestational age of 25 weeks, and required surfactant. The patient were divided into the LISA group and the INSURE group, and compared capillary gas analysis, oxygen saturation index (OSI), and morbidities.Results: The LISA group and the INSURE group included 34 and 13 newborns respectively. Demographic feature and OSI showed no significant differences between two groups. In the LISA group, pCO2 decreased over 1 hour(57.49±9.43mmHg), 2 hours(53.07±9.25mmHg, p=0.04) and 6 hours (46.50±8.53mmHg, p=0.01). pCO2 of the INSURE group decreased steeper within 2 hours (49.55±8.96mmHg to 39.56±6.20mmHg) in the INSURE group, however, the trend was not significant (p = 0.06). There were no significant differences in morbidities. Discussion: LISA and INSURE showed no significant differences in OSI and morbidities. Although LISA decreases pCO2 more slowly than INSURE, the difference is not statistical significant. LISA and INSURE are equally effective modalities for surfactant administration.

scholarly journals Neonatal Preterm Respiratory Care in Ukraine: An Observational Study of Outcomes in Relation to Timing and Methods of Surfactant Treatment

2020 ◽  
Author(s):  
Dmytro O. Dobryanskyy ◽  
Anna O. Menshykova ◽  
Zoriana V. Salabay ◽  
Olga Y. Detsyk
Keyword(s):  
Clinical Outcomes ◽  
Preterm Infants ◽  
Morbidity And Mortality ◽  
Control Group ◽  
Very Preterm Infants ◽  
Less Invasive ◽  
Very Preterm ◽  
Surfactant Administration ◽  
The Impact ◽  
Cpap Failure

Objective Timely and effective noninvasive respiratory support and surfactant administration are the key determinants of clinical outcomes in very preterm infants. The objective of this study was to evaluate the impact of the changes in clinical practice of surfactant administration on clinical outcomes and the incidence of continuous positive airway pressure (CPAP) failure defined as the need for mechanical ventilation (MV) during the first 5 days of life in preterm infants <32 weeks. Study Design One hundred sixty-five outborn very preterm infants with respiratory distress syndrome (RDS), initially managed on CPAP, were enrolled in a retrospective cohort study. Fifty-two infants treated with surfactant using less invasive or INSURE technique were included in the surfactant group. One hundred thirteen control infants received surfactant only in case of CPAP failure. Results The study groups were similar in gestational age, rates of main obstetric complications, and antenatal steroid prophylaxis. The rate of cesarean delivery was significantly higher but birth weight and need for resuscitation were lower in infants from the surfactant group. Fifty-five infants with CPAP failure (49%) received surfactant after initiation of MV in the control group in comparison with 52 (100%) in the surfactant group (p < 0.001). The incidence of CPAP failure was significantly higher in the control group (49 vs. 27%; p < 0.01) and it occurred earlier (median [interquartile range age: 4 [2–5] vs. 47 [36–99] hours, respectively; p < 0.001). Early surfactant administration significantly and independently affected the probability of CPAP failure (adjusted odds ratio: 0.29, 95% confidence interval: 0.13–0.67; p < 0.01). There were no differences in morbidities between the groups, but CPAP failure was significantly associated with higher morbidity and mortality. Conclusion Adherence to the European RDS guidelines with early rescue, less invasive surfactant administration in very preterm infants decreased the probability of CPAP failure which was significantly associated with higher morbidity and mortality. Key Points

INSURE (INtubate, SURfactant and Extubate) method in preterm infants with respiratory distress syndrome: a retrospective study

2020 ◽  
Author(s):  
Mohamed Mubarak Shaik Kidur Mohideen ◽  
Deepika Wagh ◽  
Sam Athikarisamy
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Distress Syndrome ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
P Value ◽  
Severe Respiratory Distress ◽  
Surfactant Administration

Abstract Background: Preterm infants with severe respiratory distress syndrome (RDS) are usually managed with endotracheal intubation and surfactant administration followed by mechanical ventilation however this has immediate and long-term complications. Hence, INSURE (Intubate, surfactant administration and extubate) method combined with continuous positive airway pressure (CPAP) support has been accepted as an alternative method in eligible infants. Aim of this study is to look at our experience of administering INSURE and to look at the factors predisposing to the failure of INSURE. Methods: A retrospective chart review was done of all the babies who were born in a tertiary hospital between 1 st January 2014 to 31 st December 2015 (2 years) and received surfactant through INSURE method. Infants requiring reintubation and mechanical ventilation within 3 days post INSURE are considered as INSURE failure for our study purpose. Results: Eighty-five infants were included in the review with gestational age (GA) ranging from 26 +3 to 35 +5 weeks and birth weight ranging from 680 to 3340 grams. Of these, 22 infants (26%) had INSURE failure. INSURE failure rate was higher in infants born <30 weeks gestation (40%). Higher FiO2 requirement prior to INSURE (mean FIO 2 0.5 vs 0.3, P value <0.001) and preeclampsia in mothers of infants < 30 weeks of GA (P value 0.027) were strongly associated with INSURE failure. No mortality was noted in either group. Conclusion: We found that INSURE method may be useful in preventing the need for mechanical ventilation in late preterm infants with RDS. However, this method may be less successful in preterm infants with lower GA (<30 weeks) and higher FiO2 requirement (≥0.5). More prospective studies are needed to assess the effectiveness of INSURE method.

The effect of less invasive surfactant administration on cerebral oxygenation in preterm infants

2019 ◽  
Vol 109 (2) ◽  
pp. 291-299 ◽  
Author(s):  
Kathrin Hanke ◽  
Tanja K. Rausch ◽  
Pia Paul ◽  
Isabel Hellwig ◽  
Christina Krämer ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Cerebral Oxygenation ◽  
Less Invasive ◽  
Surfactant Administration

Propofol for sedation during less invasive surfactant administration in preterm infants

2017 ◽  
Vol 102 (5) ◽  
pp. F465-F465 ◽  
Author(s):  
Claire Sophie Descamps ◽  
Marie Chevallier ◽  
Anne Ego ◽  
Isabelle Pin ◽  
Chloé Epiard ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Less Invasive ◽  
Surfactant Administration

scholarly journals Changes in Respiratory Management and the Impact on Bronchopulmonary Dysplasia

2021 ◽  
Author(s):  
Jane Chung ◽  
Anjali Iyengar ◽  
Laura Santry ◽  
Eric Swanson ◽  
Jonathan M Davis ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Bronchopulmonary Dysplasia ◽  
Clinical Course ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Respiratory Management ◽  
Wide Range ◽  
Surfactant Administration ◽  
The Impact

Objective: Non-invasive respiratory support has reduced the need for mechanical ventilation and surfactant administration in very premature neonates. We sought to determine how the increased use of non-invasive ventilation and less surfactant instillation has impacted the development of bronchopulmonary dysplasia (BPD) and compared BPD outcome applying four currently used definitions. Study Design: This is a retrospective, single center cohort study of neonates born at less than 28 weeks gestation between 2010 and 2018. A respiratory practice change (less surfactant and more non-invasive ventilation) occurred in 2014 following participation in the SUPPORT trial. Therefore, patients were divided into 2 epochs to compare postnatal respiratory and clinical course and BPD outcomes across four currently relevant definitions (VON, NICHD, Canadian, NRN). Results: Clinical and demographic variables were similar between epochs. Despite significant differences in maternal and infant characteristics and clinical course, the incidence of BPD was not significantly different between the 2 epochs regardless of the BPD definition utilized. There was a wide range in the incidence of BPD depending on the definition used. Conclusions: Despite decreased use of invasive mechanical ventilation and surfactant administration between the two epochs, the incidence of BPD did not change and there was wide variation depending on the definition used. A better understanding of the risk factors associated with BPD and a consensus definition is urgently needed in order to facilitate the conduct of clinical trials and the development of novel therapeutic interventions to improve outcome.

Sign in / Sign up

Export Citation Format

Share Document