Minimally invasive surfactant therapy in preterm infants: towards less invasive management

Authors

  • Daniel Meireles Neonatal Intensive Care Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto
  • Luísa Neiva Araújo Neonatal Intensive Care Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto
  • Marta Nascimento Neonatal Intensive Care Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto
  • Liliana Pinho Neonatal Intensive Care Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto
  • Ana Cristina Freitas Neonatal Intensive Care Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto
  • Alexandra Almeida Neonatal Intensive Care Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto
  • Carmen Carvalho Neonatal Intensive Care Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto
  • Elisa Proença Neonatal Intensive Care Unit, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto

DOI:

https://doi.org/10.25753/BirthGrowthMJ.v30.i1.19182

Keywords:

INSURE, MIST, preterm, surfactant, ventilation

Abstract

Introduction: Minimally invasive surfactant therapy (MIST) is a surfactant administration procedure that intends to reduce intubations and associated risks. The aim of this study was to compare MIST with INtubation-SURfactant-Extubation (INSURE) technique.

Material and methods: Retrospective analysis (from January 2015 to June 2019) of preterm infants on nasal continuous positive airway pressure (nCPAP) treated with surfactant.

Results: Fifty-four preterm infants were included and divided in two groups: MIST (n=34) and INSURE (n=20). No significant differences were found between groups regarding gestational age (p=0.480), birth weight (p=0.299), fraction of inspired oxygen (FiO2) prior to surfactant (p=0.220), oxygen therapy duration (p=0.306), progression to intubation (p=0.712), or length of Neonatal Intensive Care Unit stay (p=0.778). FiO2 variation before and after surfactant administration was higher in MIST group (14% vs 9%, p=0.078). No significant complications were reported with either technique.

Conclusions: MIST is a safe technique in preterm infants on nCPAP. This study shows similar outcomes with MIST and INSURE procedures, with a greater reduction in FiO2 requirements with MIST. Overall, MIST is less invasive and as effective as INSURE in preterm infants.

References

Kurepa D, Perveen S, Lipener Y, Kakkilaya V. The use of less invasive surfactant administration (LISA) in the United States with review of the literature. J Perinatol. 2019; 39:426–32.

Kanmaz HG, Erdeve O, Canpolat FE, Mutlu AB. Surfactant Administration via Thin Catheter During Spontaneous Breathing: Randomized Controlled Trial. Pediatrics. 2013; 131: e502-9.

Isayama T, Chai-Adisaksopha C, McDonald SD. Noninvasive ventilation with vs without early surfactant to prevent chronic lung disease in preterm infants: A systematic review and meta-analysis. JAMA Pediatr. 2015; 169:731–9.

Shim GH. Update of minimally invasive surfactant therapy. Korean J Pediatr. 2017; 60:273–81.

Verder H. Surfactant treatment of newborn infants with respiratory distress syndrome primarily treated with nasal continuous positive air pressure. A pilot study. Ugeskr Laeger. 1992; 154:2136–9.

Göpel W, Kribs A, Ziegler A, Reinhard L, Hoehn T, Wieg C, et al. Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): An open-label, randomised, controlled trial. Lancet. 2011; 378:1627–34.

Heidarzadeh M, Mirnia K, Hoseini MB, Sadeghnia A, Akrami F, Balila M, et al. Surfactant administration via thin catheter during spontaneous breathing: Randomized controlled trial in alzahra hospital. Iran J Neonatol. 2013; 4:5–9.

Mohammadizadeh M, Ardestani AG, Sadeghnia AR. Early administration of surfactant via a thin intratracheal catheter in preterm infants with respiratory distress syndrome: Feasibility and outcome. J Res Pharm Pract. 2015; 4:31–6.

Bao Y, Zhang G, Wu M, Ma L, Zhu J. A pilot study of less invasive surfactant administration in very preterm infants in a Chinese tertiary center. BMC Pediatr. 2015; 15:1–6.

Krajewski P, Chudzik A, Strzałko-Głoskowska B, Górska M, Kmiecik M, Wieckowska K, et al. Surfactant administration without intubation in preterm infants with respiratory distress syndrome - Our experiences. J Matern Neonatal Med. 2015; 28:1161–4.

Aguar M, Cernada M, Brugada M, Gimeno A, Gutierrez A, Vento M. Minimally invasive surfactant therapy with a gastric tube is as effective as the intubation, surfactant, and extubation technique in preterm babies. Acta Paediatr Int J Paediatr. 2014; 103:229–33.

Lau CSM, Chamberlain RS, Sun S. Less Invasive Surfactant Administration Reduces the Need for Mechanical Ventilation in Preterm Infants. Glob Pediatr Heal. 2017; 4:2333794X1769668.

Dunn MS, Kaempf J, de Klerk A, de Klerk R, Reilly M, Howard D, et al. Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates. Pediatrics. 2011:128.

Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB, et al. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med. 2008: 358:700–8.

SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network, Finer NN, Carlo WA, Walsh MC, Rich W, Gantz MG, et al. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010: 362:1970–9.

Brix N, Sellmer A, Jensen MS, Pedersen LV, Henriksen TB. Predictors for an unsuccessful INtubation-SURfactant-Extubation procedure: A cohort study. BMC Pediatr. 2014; 14:1–8.

Sandri F, Plavk R, Ancora G, Simeoni U, Stranak Z, Martinelli S, et al. Prophylactic or early selective surfactant combined with nCPAP in very preterm infants. Pediatrics. 2010; 125:e1402-9.

Mikaberidze A. “Letter to the Editor”. Int J Phytoremediation. 2007; 20:135–6.

Kribs A, Pillekamp F, Hünseler C, Vierzig A, Roth B. Early administration of surfactant in spontaneous breathing with nCPAP: Feasibility and outcome in extremely premature infants (postmenstrual age ≤27 weeks). Paediatr Anaesth. 2007; 17:364–9.

Dargaville PA, Kamlin COF, De Paoli AG, Carlin JB, Orsini F, Soll R, et al. The OPTIMIST-A trial: Evaluation of minimally-invasive surfactant therapy in preterm infants 25-28 weeks gestation. BMC Pediatr. 2014; 14:1–13.

Niemarkt HJ, Hütten MC, Kramer BW. Surfactant for Respiratory Distress Syndrome: New Ideas on a Familiar Drug with Innovative Applications. Neonatology. 2017; 111:408–14.

Aguar M, Vento M, Dargaville PA. Minimally invasive surfactant therapy: An update. Neoreviews. 2014; 15:e275-85.

More K, Sakhuja P, Shah PS. Minimally invasive surfactant administration in preterm infants: A meta-narrative review. JAMA Pediatr. 2014; 168:901–8.

Klotz D, Porcaro U, Fleck T, Fuchs H. European perspective on less invasive surfactant administration—a survey. Eur J Pediatr 2017: 176:147–54.

Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, te Pas A, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2019 Update. Neonatology. 2019; 115:432–50.

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Published

2021-04-06

How to Cite

Meireles, D., Araújo, L. N., Nascimento, M., Pinho, L., Freitas, A. C., Almeida, A., Carvalho, C., & Proença, E. (2021). Minimally invasive surfactant therapy in preterm infants: towards less invasive management. NASCER E CRESCER - BIRTH AND GROWTH MEDICAL JOURNAL, 30(1), 18–25. https://doi.org/10.25753/BirthGrowthMJ.v30.i1.19182

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