scholarly journals Efficacy and safety of minimally invasive surfactant administration in preterm infants with neonatal respiratory distress syndrome: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Xiao Hong Wu ◽  
Zhoushan Feng ◽  
Juan Kong ◽  
Yiyu Lai ◽  
Chunhong Jia ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Minimally Invasive ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Distress Syndrome ◽  
Meta Analysis ◽  
Control Group ◽  
Neonatal Respiratory Distress ◽  
Surfactant Administration

Abstract Background: The effects of minimally invasive surfactant administration (MISA) in preterm infants with neonatal respiratory distress syndrome (NRDS) are unclear. Methods: We searched randomized controlled trials (RCTs) and compared MISA techniques with intubation for surfactant delivery in preterm infants with NRDS in PubMed, Embase, Cochrane Library, and Web of Science. Results: Thirteen RCTs (1931 infants) were included in the meta-analysis. The use of MISA techniques decrease the incidence of bronchopulmonary dysplasia (BPD) at 36 weeks, pneumothorax, and hemodynamically significant patent ductus arteriosus (hsPDA) (Risk Ratio(RR) : 0.59, 95% confidence interval (CI) : 0.46 to 0.75, p < .0001; RR : 0.60, 95% CI : 0.39 to 0.93, p= .02 and RR : 0.88, 95% CI : 0.78 to 1.00, p= .04, respectively). In addition, infants in the MISA group required less mechanical ventilation within 72 h of life or during hospitalization (RR : 0.60, 95% CI : 0.48 to 0.75, p< .00001 and RR : 0.64, 95% CI : 0.49 to 0.82, p = .0005, respectively) compared with infants in the control group. However, the rate of surfactant reflux was higher in the MISA group than that in the control group (RR : 2.12, 95% CI : 1.37 to 3.29, p = .0008). There were no significant differences in mortality and other outcomes beteween the MISA group and the control group. Conclusions: The administration of surfactant with MISA techniques could lower the requirement for mechanical ventilation, and decrease the incidence of BPD at 36 weeks, pneumothorax, and hsPDA.

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.

scholarly journals Novel Approaches to Surfactant Administration

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Samir Gupta ◽  
Steven M. Donn
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Preterm Infants ◽  
Noninvasive Ventilation ◽  
Clinical Evidence ◽  
Distress Syndrome ◽  
Surfactant Replacement Therapy ◽  
Surfactant Administration ◽  
Novel Approaches

Surfactant replacement therapy has been the mainstay of treatment for preterm infants with respiratory distress syndrome for more than twenty years. For the most part, surfactant is administered intratracheally, followed by mechanical ventilation. In recent years, the growing interest in noninvasive ventilation has led to novel approaches of administration. This paper will review these techniques and the associated clinical evidence.

scholarly journals Association of Antenatal Corticosteroid Administration-to-delivery Interval With Neonatal Respiratory Distress Syndrome and Respiratory Support in Preterm Infants

2022 ◽  
Author(s):  
Lixia Li ◽  
Haijing Li ◽  
Yejun Jiang ◽  
Beimeng Yu ◽  
Xiuren Wang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Neonatal Mortality ◽  
Preterm Infants ◽  
Birth Interval ◽  
Distress Syndrome ◽  
Delivery Room ◽  
Respiratory Support ◽  
Neonatal Respiratory Distress

Abstract Background: Administration of antenatal corticosteroids (ACS) is an effective strategy for the management of preterm infants, which can improve neonatal respiratory distress syndrome (NRDS) and attenuate the risk of neonatal mortality. However, many preterm infants do not expose to a complete course of ACS administration, and the effects of different ACS-to-delivery intervals on NRDS and respiratory support remain unclear.we explore the relationships of ACS administration-to-birth intervals with NRDS and respiratory support in preterm infants in this study.Methods: In this retrospective cohort study, the preterm infants born between 240/7 and 316/7 wk of gestation were recruited from Jan 2015 to Jul 2021. All participants were categorized based on the time interval from the first ACS dose to delivery: <24 h, 1-2 d, 2-7 d, and more >7 d. Multivariable logistic regression analysis was conducted to examine the relationships between ACS-to-birth interval and primary or secondary outcome, while adjusting for potential confounders.Results: Of the 706 eligible neonates, 264, 83, 292 and 67 received ACS-to-delivery intervals of <24 h, 1-2 d, 2-7 d and >7 d, respectively. After adjusting these confounding factors, multivariable logistic analysis showed a significant increased risk of NRDS (aOR: 1.8, 95% CI: 1.2-2.7), neonatal mortality (aOR: 2.8, 95% CI: 1.1-6.8), the need for surfactant use (aOR: 2.7, 95% CI: 1.7-4.4), endotracheal intubation in delivery room (aOR: 1.9, 95% CI: 1.0-3.7), mechanical ventilation (aOR: 1.9, 95% CI: 1.1-3.4) in the ACS-to-delivery interval of <24 h group when compared with the ACS-to-birth interval of 2-7 d group. Similar findings were observed in the subgroup analysis of the ACS interval of <6 h and 6-12 h groups (incidence of death and surfactant use), but no obvious differences were found in the ACS intervals of 12-24 h, 1-2 d and >7 d groups compared with the ACS-to-birth interval of 2-7 d group.Conclusions: Neonatal outcomes such as NRDS, neonatal mortality, the need for surfactant use, intubation in delivery room, mechanical ventilation are at a higher risk when the neonates exposed to ACS interval for less than 12 h before delivery.

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