The Miracles of Surfactant: Less Invasive Surfactant Administration, Nebulization, and Carrier of Topical Drugs

Surfactant replacement therapy (SRT) has long become the standard of care in the treatment of neonatal respiratory distress syndrome (RDS), significantly decreasing acute pulmonary morbidity and mortality in preterm infants. For decades, this beneficial replacement therapy has been administered via endotracheal tube. Despite significantly improving the outcome of RDS, however, the burden of bronchopulmonary dysplasia remains, in particular, in very immature preterm infants. Acknowledging the direct relationship between exposure to and duration of invasive mechanical ventilation and chronic lung disease, the latter has been gradually replaced by noninvasive ventilation strategies in neonatal RDS. This replacement is strongly related to the demand for similarly noninvasive modes of surfactant administration. Alternative techniques in spontaneously breathing infants have evolved, including less invasive techniques using thin catheters (less invasive surfactant administration and minimally invasive surfactant treatment) as well as nebulization of surfactant, although the latter is not ready for clinical application yet. In addition, given their therapeutic delivery to the lungs and subsequent alveolar distribution, surfactant preparations represent an attractive vehicle for pulmonary deposition of drugs in preterm infants. Further improvement of SRT and expansion of the field of application of lung surfactant may hold additional benefits, especially in the treatment of the most immature preterm infants.

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Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants

Acta Paediatrica ◽

10.1111/apa.12883 ◽

2015 ◽

Vol 104 (3) ◽

pp. 241-246 ◽

Cited By ~ 53

Author(s):

Wolfgang Göpel ◽

Angela Kribs ◽

Christoph Härtel ◽

Stefan Avenarius ◽

Norbert Teig ◽

...

Keyword(s):

Preterm Infants ◽

Less Invasive ◽

Surfactant Administration ◽

Spontaneously Breathing

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

10.21203/rs.3.rs-58663/v1 ◽

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.

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Evaluation of surfactant replacement therapy effects: A new potential role of lung ultrasound

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1512669l ◽

2015 ◽

Vol 143 (11-12) ◽

pp. 669-675 ◽

Cited By ~ 6

Author(s):

Jovan Lovrenski ◽

Erich Sorantin ◽

Sanja Stojanovic ◽

Aleksandra Doronjski ◽

Aleksandra Lovrenski

Keyword(s):

Replacement Therapy ◽

Preterm Infants ◽

Distress Syndrome ◽

Lung Ultrasound ◽

Grading System ◽

Surfactant Replacement ◽

Surfactant Replacement Therapy ◽

Surfactant Administration ◽

Us Findings

Introduction. Previous studies suggested that effects of the surfactant administration in preterm infants with respiratory distress syndrome cannot be followed by lung ultrasound (L-US). Objective. The aim of the paper is to evaluate the surfactant replacement therapy effects using a new, proposed grading system for L-US findings. Methods. We report the series of 12 preterm infants with clinical and radiographic signs of respiratory distress syndrome, in whom L-US examinations were performed prior to, and within the first 24 hours after surfactant administration. To evaluate the surfactant replacement therapy effects, we proposed a new grading system (1 to 6) for L-US findings at each examined lung area, based on the presence of normal finding, the amount of B-lines and subpleural consolidations. Results. All preterm infants had an improvement of L-US findings from one to four grades observed within the first 24 hours after surfactant administration, which has not been previously reported. The improvement of L-US findings was most commonly observed in anterior lung areas. Conclusion. L-US might enable an early detection of the surfactant replacement therapy effects. Further prospective studies are necessary to define the role of L-US in this field.

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Surfactant Replacement Therapy in Preterm Infants: A European Survey

Neonatology ◽

10.1159/000322004 ◽

2011 ◽

Vol 100 (1) ◽

pp. 71-77 ◽

Cited By ~ 13

Author(s):

Anton H. van Kaam ◽

Anne P. De Jaegere ◽

Dorine Borensztajn ◽

Peter C. Rimensberger

Keyword(s):

Replacement Therapy ◽

Preterm Infants ◽

Surfactant Replacement ◽

European Survey ◽

Surfactant Replacement Therapy

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Late Breaking Abstract - Less invasive surfactant administration (LISA) to preterm infants on high flow nasal cannula (nHFT)

10.1183/13993003.congress-2021.oa3963 ◽

2021 ◽

Author(s):

Asad Nasim ◽

Sanja Zivanovic ◽

Muhammad Abubakar ◽

Alexandra Scrivens ◽

Charles Roehr

Keyword(s):

Preterm Infants ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Less Invasive ◽

Surfactant Administration

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Minimally or less invasive surfactant replacement therapy in neonates: A narrative review

Journal of Clinical Neonatology ◽

10.4103/jcn.jcn_2_21 ◽

2022 ◽

Vol 11 (1) ◽

pp. 45

Author(s):

Gengaimuthu Karthikeyan

Keyword(s):

Replacement Therapy ◽

Narrative Review ◽

Less Invasive ◽

Surfactant Replacement ◽

Surfactant Replacement Therapy

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Is Less Invasive Surfactant Administration Necessary or “Only” Helpful or Just a Fashion?

American Journal of Perinatology ◽

10.1055/s-0038-1637759 ◽

2018 ◽

Vol 35 (06) ◽

pp. 530-533 ◽

Cited By ~ 4

Author(s):

Ilia Bresesti ◽

Laura Fabbri ◽

Gianluca Lista

Keyword(s):

Large Scale ◽

Exogenous Surfactant ◽

Preterm Neonates ◽

Positive Pressure ◽

Less Invasive ◽

Antenatal Steroids ◽

Surfactant Replacement Therapy ◽

Short And Long Term ◽

Surfactant Administration ◽

A New Technique

AbstractIn the 1990s, the most relevant pillars in the treatment of neonatal respiratory distress syndrome (RDS) have been improvements in ventilation strategies, the introduction of exogenous surfactant replacement therapy, and the use of antenatal steroids. Lately, in addition to the standard INSURE (INtubation–SURfactant administration–Extubation) method to administer surfactant, a new technique has been gaining increasing popularity. It is the so-called less invasive surfactant administration (LISA) method, which has shown promising results in preventing bronchopulmonary dysplasia development and in reducing mortality in preterm neonates. The rationale behind this technique is to avoid positive pressure ventilation and the endotracheal tube, being surfactant delivered through a thin catheter while the neonate is maintained on continuous positive airway pressure. Given the paucity of large-scale randomized trials on LISA method to prove its effects on short- and long-term outcomes, some questions still remain unanswered. Then, uncertainty regarding the feasibility of this maneuver needs to be better clarified before gaining wide acceptance in routine clinical practice. In our report, we aim at hypothesizing the main mechanisms behind the efficacy of LISA, considering it as a single maneuver in a comprehensive approach for RDS management in the delivery room.

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