1
|
Abdallah Y, Mkony M, Noorani M, Moshiro R, Bakari M, Manji K. CPAP failure in the management of preterm neonates with respiratory distress syndrome where surfactant is scarce. A prospective observational study. BMC Pediatr 2023; 23:211. [PMID: 37138252 PMCID: PMC10155133 DOI: 10.1186/s12887-023-04038-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/26/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND The mainstay in the management of preterm neonates with respiratory distress syndrome (RDS) include early Continuous Positive Airway Pressure (CPAP), timely surfactant replacement and mechanical ventilation. Preterm neonates with RDS who fail CPAP are at higher risk for chronic lung disease as well as death. Unfortunately, in low resource settings CPAP may be the only treatment available for these neonates. OBJECTIVE To determine the prevalence of CPAP failure among premature newborns with RDS and associated factors. METHODS We conducted a prospective observational study over the first 72 h of life on 174 preterm newborns with RDS receiving CPAP at Muhimbili National Hospital (MNH). At MNH newborns with Silverman Andersen Score (SAS) of ≥ 3 are commenced on CPAP; surfactant and mechanical ventilation are very scarce. Study newborns not maintaining oxygen saturation > 90% or with SAS score ≥ 6 despite being on 50% oxygen and PEEP of 6 cmH2O and those with > 2 episodes of apnoea needing stimulation or positive pressure ventilation in 24 h were considered as CPAP failure. The prevalence of CPAP failure was determined as a percentage and factors associated were determined by logistic regression. A p-value of < 0.05 was considered significant and 95% confidence interval was used. RESULTS Of the enrolled newborns, 48% were male and 91.4% were in-born. The mean gestational age and weight were 29 weeks (range 24-34 weeks) and 1157.7 g (range 800-1500 g) respectively. Of the mothers 44 (25%) received antenatal corticosteroids. Overall CPAP failure was 37.4% and among those weighing ≤ 1200g, it was 44.1% . Most failure occurred within the first 24 h. No factor was identified to be independently associated with CPAP failure. Mortality among those who failed CPAP was 33.8% and 12.8% among those who did not. CONCLUSIONS In resource limited settings like ours with low up take of antenatal corticosteroids and scarce surfactant replacement a significant portion of preterm neonates especially those weighing ≤ 1200 g with RDS fail CPAP therapy.
Collapse
Affiliation(s)
- Yaser Abdallah
- Department of Paediatrics and Child Health, Aga Khan University, P.o Box 38129, Dar es Salaam, Tanzania.
- Department of Paediatrics and Child Health, Muhimbili National Hospital and Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Martha Mkony
- Department of Paediatrics and Child Health, Muhimbili National Hospital and Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mariam Noorani
- Department of Paediatrics and Child Health, Aga Khan University, P.o Box 38129, Dar es Salaam, Tanzania
- Department of Paediatrics and Child Health, Muhimbili National Hospital and Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Robert Moshiro
- Department of Paediatrics and Child Health, Muhimbili National Hospital and Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mohamed Bakari
- Department of Paediatrics and Child Health, Muhimbili National Hospital and Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili National Hospital and Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| |
Collapse
|
2
|
Ramaswamy VV, Abiramalatha T, Bandyopadhyay T, Shaik NB, Pullattayil S AK, Cavallin F, Roehr CC, Trevisanuto D. Delivery room CPAP in improving outcomes of preterm neonates in low-and middle-income countries: A systematic review and network meta-analysis. Resuscitation 2021; 170:250-263. [PMID: 34757058 DOI: 10.1016/j.resuscitation.2021.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
AIM To study the impact of delivery room continuous positive airway pressure (DRCPAP) on outcomes of preterm neonates in low- and middle- income countries (LMICs) by comparing with interventions: oxygen supplementation, late DRCPAP, DRCPAP with sustained inflation, DRCPAP with surfactant and invasive mechanical ventilation (IMV). METHODS Medline, Embase, CENTRAL, WOS and CINAHL searched. Observational studies and randomized controlled trials (RCTs) were included. Pair-wise meta-analysis and Bayesian network meta-analysis (NMA) were utilized. Primary outcome was receipt of IMV. RESULTS Data from 11 of the 18 included studies (4 observational studies, 7 RCTs) enrolling 4210 preterm infants was synthesized. Moderate certainty of evidence (CoE) from NMA of RCTs comparing DRCPAP with surfactant administration versus DRCPAP alone suggested no decrease in subsequent receipt of IMV [Risk ratio (RR); 95% Credible Interval (CrI): 0.73; (0.34, 1.40)]. Very low CoE from observational studies comparing use of DRCPAP versus oxygen supplementation indicated a trend towards decreased IMV [RR; 95% Confidence Interval (CI): 0.75; (0.56-1.00)]. Although moderate CoE from NMA evaluating DRCPAP versus oxygen supplementation showed a trend towards decreased receipt of surfactant, it did not reach statistical significance [RR; 95% CrI: 0.69; (0.44, 1.06)]. Moderate CoE from NMA indicated that none of the interventions, when compared with use of supplemental oxygen alone or with each other decreased mortality or bronchopulmonary dysplasia. LIMITATIONS CoE was very low for primary outcome. CONCLUSIONS Present evidence is not sufficient for use of DRCPAP, but also did not show harm. Since it seems unlikely that there are marked variations in patient physiology to explain the difference in efficacy between high income countries and LMICs, we suggest future research evaluating other barriers in improving the effectiveness of DRCPAP in LMICs.
Collapse
Affiliation(s)
| | - Thangaraj Abiramalatha
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Tapas Bandyopadhyay
- Department of Neonatology, Dr Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Nasreen Banu Shaik
- Department of Neonatology, Ankura Hospital for Women and Children, Hyderabad, India
| | | | | | - Charles Christoph Roehr
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences, Division, University of Oxford, Oxford, United Kingdom; Newborn Services, Southmead Hospital, North Bristol Trust, Bristol, United Kingdom; University of Bristol, Women's and Children Division, Bristol, United Kingdom
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy.
| |
Collapse
|
3
|
Jeetoo SD, Smith J, Pitcher RD. Radiological Studies in Very Low Birth Weight and Extremely Low Birth Weight Neonates: 'ALARA' Revisited. J Trop Pediatr 2020; 66:403-411. [PMID: 31891406 DOI: 10.1093/tropej/fmz080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Very low birth weight (VLBW) and extremely low birth weight (ELBW) neonates are particularly susceptible to the adverse effects of ionizing radiation. There are limited data on radiographic practice among this population in resource-limited environments. AIM To estimate cumulative effective dose (ED) from diagnostic imaging in VLBW (1000-1500 g) and ELBW (<1000 g) neonates in a resource-limited setting. METHOD A retrospective analysis of all diagnostic imaging examinations performed on ELBW and VLBW neonates born in a large South African public-sector tertiary-level hospital from January through June 2015. Data were stratified by birth weight and imaging examination. The ED was estimated according to the method of Puch-Kapst. Non-parametric t-tests compared the number of radiographs and ED in VLBW and ELBW neonates, at 5% significance. RESULTS Three hundred and ninety-three neonates with median birth weight 1130 (IQR: 930-1340) g were included; 265 (67%) were VLBW and 128 (33%) ELBW; 48 (12%) died at a median of 7 (IQR: 2-17) days. A median of 2 (IQR: 1-5) radiographs were performed per neonate, with median ED 28.8 (IQR: 14.4-90.8) μSv. The median radiographic exposures for VLBW and ELBW neonates were 1 (IQR: 1-4) and 4 (IQR: 2-9), respectively, (p < 0.0001) with median ED 14.4 (IQR: 14.4-70.4) μSv and 71.2 (IQR: 28.8-169.3) μSv, respectively, (p < 0.0001). Radiographic exposure for VLBW neonates was lower than previously documented for this population. CONCLUSION Neonatal radiographic practice in resource-limited settings has the potential to contribute to the discourse on international best practice.
Collapse
Affiliation(s)
- Surjit Damon Jeetoo
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Johan Smith
- Department of Paediatrics, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Richard Denys Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| |
Collapse
|
4
|
Dewez JE, Nangia S, Chellani H, White S, Mathai M, van den Broek N. Availability and use of continuous positive airway pressure (CPAP) for neonatal care in public health facilities in India: a cross-sectional cluster survey. BMJ Open 2020; 10:e031128. [PMID: 32114460 PMCID: PMC7053015 DOI: 10.1136/bmjopen-2019-031128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the availability of continuous positive airway pressure (CPAP) and to provide an overview of its use in neonatal units in government hospitals across India. SETTING Cross-sectional cluster survey of a nationally representative sample of government hospitals from across India. PRIMARY OUTCOMES Availability of CPAP in neonatal units. SECONDARY OUTCOMES Proportion of hospitals where infrastructure and processes to provide CPAP are available. Case fatality rates and complication rates of neonates treated with CPAP. RESULTS Among 661 of 694 government hospitals with neonatal units that provided information on availability of CPAP for neonatal care, 68.3% of medical college hospitals (MCH) and 36.6% of district hospitals (DH) used CPAP in neonates. Assessment of a representative sample of 142 hospitals (79 MCH and 63 DH) showed that air-oxygen blenders were available in 50.7% (95% CI 41.4% to 60.9%) and staff trained in the use of CPAP were present in 56.0% (45.8% to 65.8%) of hospitals. The nurse to patient ratio was 7.3 (6.4 to 8.5) in MCH and 6.6 (5.5 to 8.3) in DH. Clinical guidelines were available in 31.0% of hospitals (22.2% to 41.4%). Upper oxygen saturation limits of above 94% were used in 72% (59.8% to 81.6%) of MCH and 59.3% (44.6% to 72.5%) of DH. Respiratory circuits were reused in 53.8% (42.3% to 63.9%) of hospitals. Case fatality rate for neonates treated with CPAP was 21.4% (16.6% to 26.2%); complication rates were 0.7% (0.2% to 1.2%) for pneumothorax, 7.4% (0.9% to 13.9%) for retinopathy and 1.4% (0.7% to 2.1%) for bronchopulmonary dysplasia. CONCLUSIONS CPAP is used in neonatal units across government hospitals in India. Neonates may be overexposed to oxygen as the means to detect and treat consequences of oxygen toxicity are insufficient. Neonates may also be exposed to nosocomial infections by reuse of disposables. Case fatality rates for neonates receiving CPAP are high. Complications might be under-reported. Support to infrastructure, training, guidelines implementation and staffing are needed to improve CPAP use.
Collapse
Affiliation(s)
- Juan Emmanuel Dewez
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Sushma Nangia
- Department of Neonatology, Lady Hardinge Medical College and Kalawati Saran Hospital, New Delhi, Delhi, India
| | - Harish Chellani
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Sarah White
- Department of International Public Health, Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Matthews Mathai
- Department of International Public Health, Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nynke van den Broek
- Department of International Public Health, Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
5
|
Van Wyk L, Tooke L, Dippenaar R, Rhoda N, Lloyd L, Holgate S, Alexander R, Smith J. Optimal Ventilation and Surfactant Therapy in Very-Low-Birth-Weight Infants in Resource-Restricted Regions. Neonatology 2020; 117:217-224. [PMID: 32454492 DOI: 10.1159/000506987] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 11/19/2022]
Abstract
In resource-restricted regions, respiratory distress syndrome (RDS) data are often underreported, making the determination of effective interventions and their outcome difficult. The combination of oxygen, nasal continuous positive airway pressure (CPAP) and surfactant therapy has the potential to prevent 42% of RDS-related deaths in sub-Saharan Africa, despite the financial implications. This article provides a brief overview on the status of RDS management, mainly nasal CPAP and surfactant therapy in very-low-birth-weight infants, in resource-restricted regions of sub-Saharan Africa. Data from the public health sector, as compared to the private health sector, of the Western Cape province, South Africa, are used to illustrate what RDS management strategies are able to accomplish in a resource-restricted region. Upscaling of all components (antenatal care, antenatal corticosteroids, prevention of hypothermia and RDS management strategies) are required to decrease premature infant mortality rates in resource-restricted areas.
Collapse
Affiliation(s)
- Lizelle Van Wyk
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa,
| | - Lloyd Tooke
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Ricky Dippenaar
- NICU, N1 City and Blaauwberg Hospital, Cape Town, South Africa
| | - Natasha Rhoda
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Lizel Lloyd
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Sandi Holgate
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | - Johan Smith
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.,Panorama Medi-Clinic, Cape Town, South Africa
| |
Collapse
|
6
|
Szél B, Reiger Z, Urbán E, Lázár A, Mader K, Damjanova I, Nagy K, Tálosi G. Successful elimination of extended-spectrum beta-lactamase (ESBL)-producing nosocomial bacteria at a neonatal intensive care unit. World J Pediatr 2017; 13:210-216. [PMID: 27878781 DOI: 10.1007/s12519-016-0069-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 05/06/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria are highly dangerous to neonates. At our Neonatal Intensive Care Unit (NICU), the presence of these bacteria became so threatening in 2011 that immediate intervention was required. METHODS This study was conducted during a nearly two-year period consisting of three phases: retrospective (9 months), educational (3 months) and prospective (9 months). Based on retrospective data analysis, a complex management plan was devised involving the introduction of the INSURE protocol, changes to the antibiotic regimen, microbiological screening at short intervals, progressive feeding, a safer bathing protocol, staff hand hygiene training and continuous monitoring of the number of newly infected and newly colonized patients. During these intervals, a total of 355 patients were monitored. RESULTS Both ESBL-producing Enterobacter cloaceae and Klebsiella pneumoniae were found (in both patients and environmental samples). In the prospective period a significant reduction could be seen in the average number of both colonized (26/167 patients; P=0.029) and infected (3/167 patients; P=0.033) patients compared to data from the retrospective period regarding colonized (72/188 patients) and infected (9/188 patients) patients. There was a decrease in the average number of patient-days (from 343.72 to 292.44 days per months), though this difference is not significant (P=0.058). During the prospective period, indirect hand hygiene compliance showed a significant increase (from the previous 26.02 to 33.6 hand hygiene procedures per patient per hospital day, P<0.001). CONCLUSION Colonizations and infections were rolled back successfully in a multi-step effort that required an interdisciplinary approach.
Collapse
Affiliation(s)
- Borbála Szél
- Infection Control Unit, University of Szeged, Szeged, Hungary.
| | - Zsolt Reiger
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Edit Urbán
- Institute of Clinical Microbiology, University of Szeged, Szeged, Hungary
| | - Andrea Lázár
- Institute of Clinical Microbiology, University of Szeged, Szeged, Hungary
| | - Krisztina Mader
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Ivelina Damjanova
- Department of Bacteriology, National Center for Epidemiology, Budapest, Hungary
| | - Kamilla Nagy
- Infection Control Unit, University of Szeged, Szeged, Hungary
| | - Gyula Tálosi
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| |
Collapse
|
7
|
Zhang H, Zhang J, Zhao S. Airway damage of prematurity: The impact of prolonged intubation, ventilation, and chronic lung disease. Semin Fetal Neonatal Med 2016; 21:246-53. [PMID: 27129915 DOI: 10.1016/j.siny.2016.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Over the past four decades, advances in neonatal intensive care have led to the survival of smaller and more immature infants. The improved survival of very low birth weight infants is associated with long term respiratory morbidity, most frequently in the form of bronchopulmonary dysplasia. In this review, we will discuss the pathogenesis, risk factor as well as management of commonly seen acquired airway disorders associated with prematurity, prolonged intubation and ventilation.
Collapse
Affiliation(s)
- Huayan Zhang
- The Children's Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Jie Zhang
- Department of Otolaryngology, Beijing Children's Hospital, Beijing, China
| | - Shunying Zhao
- Department of Pulmonary Medicine, Beijing Children's Hospital, Beijing, China
| |
Collapse
|
8
|
Ognean ML, Stoicescu SM, Boantă O, Năstase L, Gliga C, Cucerea M. Intubation-Surfactant: Extubation on Continuous Positive Pressure Ventilation. Who are the Best Candidates? J Crit Care Med (Targu Mures) 2016; 2:73-79. [PMID: 29967841 DOI: 10.1515/jccm-2016-0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/30/2016] [Indexed: 11/15/2022] Open
Abstract
Introduction Respiratory distress syndrome (RDS) continues to be the leading cause of illness and death in preterm infants. Studies indicate that INSURE strategy (INtubate-SURfactant administration and Extubate to nasal continuous positive airway pressure [nCPAP]) is better than mechanical ventilation (MV) with rescue surfactant, for the management of respiratory distress syndrome (RDS) in very low birth weight (VLBW) neonates, as it has a synergistic effect on alveolar stability. Aim of the study To identify the factors associated with INSURE strategy failure in preterm infants with gestational age (GA) ≤ 32 weeks. Materials and Methods This was a retrospective cohort study, based on data collected in the Romanian National Registry for RDS patients by three regional (level III) centers between 01.01.2010 and 31.12.2011. All preterm infants of ≤ 32 weeks GA were included. Prenatal and neonatal information were compared between (Group 1), the preterm infants successfully treated using INtubation-SURfactant-Extubation on nasal CPAP (INSURE) strategy and (Group 2 ), those who needed mechanical ventilation within seventy two hours after INSURE. Results A total of 637 preterm infants with GA ≤ 32 weeks were included in the study. INSURE strategy was performed in fifty seven cases (8.9%) [ Group 1] and was successful in thirty one patients (54.4%). No differences were found as regards the studied prenatal and intranatal characteristics between (Group 1) and Group 2 who needed mechanical ventilation. Group 2 preterm infants who needed mechanical ventilation within 72 hours after INSURE had significantly lower mean Apgar scores at 1 and 5 minutes and lower peripheral oxygen saturation (SpO2) during resuscitation at birth (p<0.05). Successful INSURE strategy was associated with greater GA, birth weight (BW), fraction of inspired oxygen (FiO2) during resuscitation, and an increased mean dose of surfactant but these associations were not statistically significant (p>0.5). Conclusion In preterm infants ≤ 32 weeks gestation, increased INSURE failure rates are associated with complicated pregnancies, significantly lower Apgar scores at 1 and 5 minutes, and lower peripheral oxygen saturation during resuscitation.
Collapse
Affiliation(s)
- Maria Livia Ognean
- Clinical County Emergency Hospital Sibiu, Neonatology Department, Sibiu, Romania
| | - Silvia-Maria Stoicescu
- University of Medicine and Pharmacy Carol Davila Bucuresti, Institute of Mother and Child Care - Polizu, Neonatology Department, Bucharest, Romania
| | - Oana Boantă
- Clinical County Emergency Hospital Sibiu, Neonatology Department, Sibiu, Romania
| | - Leonard Năstase
- University of Medicine and Pharmacy Carol Davila Bucuresti, Institute of Mother and Child Care - Polizu, Neonatology Department, Bucharest, Romania
| | - Carmen Gliga
- Clinical County Emergency Hospital Târgu Mureş, Regional Neonatal Intensive Care Center, Târgu Mureş, Romania
| | - Manuela Cucerea
- Clinical County Emergency Hospital Târgu Mureş, Regional Neonatal Intensive Care Center, Târgu Mureş, Romania.,University of Medicine and Pharmacy Târgu Mureş, Târgu Mureş, Romania
| |
Collapse
|
9
|
Sankar MJ, Gupta N, Jain K, Agarwal R, Paul VK. Efficacy and safety of surfactant replacement therapy for preterm neonates with respiratory distress syndrome in low- and middle-income countries: a systematic review. J Perinatol 2016; 36 Suppl 1:S36-48. [PMID: 27109091 PMCID: PMC4848743 DOI: 10.1038/jp.2016.31] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/07/2015] [Accepted: 01/27/2016] [Indexed: 11/09/2022]
Abstract
Surfactant replacement therapy (SRT) has been shown to reduce mortality and air leaks in preterm neonates from high-income countries (HICs). The safety and efficacy of SRT in low- and middle- income countries (LMICs) have not been systematically evaluated. The major objectives of this review were to assess the (1) efficacy and safety, and (2) feasibility and cost effectiveness of SRT in LMIC settings. We searched the following databases-MEDLINE, CENTRAL, CINAHL, EMBASE and WHOLIS using the search terms 'surfactant' OR 'pulmonary surfactant'. Both experimental and observational studies that enrolled preterm neonates with or at-risk of respiratory distress syndrome (RDS) and required surfactant (animal-derived or synthetic) were included. A total of 38 relevant studies were found; almost all were from level-3 neonatal units. Pooled analysis of two randomized controlled trials (RCTs) and 22 observational studies showed a significant reduction in mortality at the last available time point in neonates who received SRT (relative risk (RR) 0.67; 95% confidence interval (CI) 0.57 to 0.79). There was also a significant reduction in the risk of air leaks (five studies; RR 0.51; 0.29 to 0.90). One RCT and twelve observational studies reported the risk of bronchopulmonary dysplasia (BPD) with contrasting results; while the RCT and most before-after/cohort studies showed a significant reduction or no effect, the majority of the case-control studies demonstrated significantly higher odds of receiving SRT in neonates who developed BPD. Two studies-one RCT and one observational-found no difference in the proportion of neonates developing pulmonary hemorrhage, while another observational study reported a higher incidence in those receiving SRT. The failure rate of the intubate-surfactant-extubate (InSurE) technique requiring mechanical ventilation or referral varied from 34 to 45% in four case-series. No study reported on the cost effectiveness of SRT. Available evidence suggests that SRT is effective, safe and feasible in level-3 neonatal units and has the potential to reduce neonatal mortality and air leaks in low-resource settings as well. However, there is a need to generate more evidence on the cost effectiveness of SRT and its effect on BPD in LMIC settings.
Collapse
Affiliation(s)
- M J Sankar
- Department of Pediatrics, Newborn Health Knowledge Centre, ICMR Center for Advanced Research in Newborn Health, WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences, New Delhi, India
| | - N Gupta
- Department of Pediatrics, Newborn Health Knowledge Centre, ICMR Center for Advanced Research in Newborn Health, WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences, New Delhi, India
| | - K Jain
- Department of Pediatrics, Newborn Health Knowledge Centre, ICMR Center for Advanced Research in Newborn Health, WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences, New Delhi, India
| | - R Agarwal
- Department of Pediatrics, Newborn Health Knowledge Centre, ICMR Center for Advanced Research in Newborn Health, WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences, New Delhi, India
| | - V K Paul
- Department of Pediatrics, Newborn Health Knowledge Centre, ICMR Center for Advanced Research in Newborn Health, WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
10
|
Efficacy and safety of CPAP in low- and middle-income countries. J Perinatol 2016; 36 Suppl 1:S21-8. [PMID: 27109089 PMCID: PMC4848740 DOI: 10.1038/jp.2016.29] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 11/14/2022]
Abstract
We conducted a systematic review to evaluate the (1) feasibility and efficacy and (2) safety and cost effectiveness of continuous positive airway pressure (CPAP) therapy in low- and middle-income countries (LMIC). We searched the following electronic bibliographic databases-MEDLINE, Cochrane CENTRAL, CINAHL, EMBASE and WHOLIS-up to December 2014 and included all studies that enrolled neonates requiring CPAP therapy for any indication. We did not find any randomized trials from LMICs that have evaluated the efficacy of CPAP therapy. Pooled analysis of four observational studies showed 66% reduction in in-hospital mortality following CPAP in preterm neonates (odds ratio 0.34, 95% confidence interval (CI) 0.14 to 0.82). One study reported 50% reduction in the need for mechanical ventilation following the introduction of bubble CPAP (relative risk 0.5, 95% CI 0.37 to 0.66). The proportion of neonates who failed CPAP and required mechanical ventilation varied from 20 to 40% (eight studies). The incidence of air leaks varied from 0 to 7.2% (nine studies). One study reported a significant reduction in the cost of surfactant usage with the introduction of CPAP. Available evidence suggests that CPAP is a safe and effective mode of therapy in preterm neonates with respiratory distress in LMICs. It reduces the in-hospital mortality and the need for ventilation thereby minimizing the need for up-transfer to a referral hospital. But given the overall paucity of studies and the low quality evidence underscores the need for large high-quality studies on the safety, efficacy and cost effectiveness of CPAP therapy in these settings.
Collapse
|
11
|
Pinheiro JMB, Santana-Rivas Q, Pezzano C. Randomized trial of laryngeal mask airway versus endotracheal intubation for surfactant delivery. J Perinatol 2016; 36:196-201. [PMID: 26633145 DOI: 10.1038/jp.2015.177] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 09/01/2015] [Accepted: 10/07/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare the effectiveness of surfactant delivery via endotracheal tube (ETT) using an intubation-surfactant-rapid extubation approach with premedication) vs laryngeal mask airway (LMA) in preventing the need for mechanical ventilation in preterm neonates with moderate respiratory distress syndrome (RDS). STUDY DESIGN Moderately preterm infants diagnosed with RDS, receiving nasal continuous positive airway pressure with FiO2 0.30 to 0.60, were randomized to two groups at age 3 to 48 h. Those in the ETT group were intubated following premedication with atropine and morphine, whereas the LMA group received only atropine. Both groups received calfactant before a planned reinstitution of nasal continuous positive airway pressure, and had equivalent pre-specified criteria for subsequent mechanical ventilation and surfactant retreatment. The primary outcome was failure of surfactant treatment strategy to avoid mechanical ventilation; we differentiated early from late failures to assess the contribution of potential mechanisms such as respiratory depression versus less-effective surfactant delivery. Secondary outcomes addressed efficacy and safety end points. RESULT Sixty-one patients were randomized, one excluded and 30 analyzed in each group, with similar baseline characteristics. Failure rate was 77% in the ETT group and 30% in the LMA group (P<0.001). The difference was related to early failure, as late failure rates did not differ between groups. FiO2 decrease after surfactant and rates of adverse events were similar between groups. CONCLUSION Surfactant therapy through an LMA decreases the proportion of newborns with moderate RDS who require mechanical ventilation, when compared with a standard endotracheal intubation procedure with sedation. The efficacy of surfactant in decreasing RDS severity appears similar with both methods. Morphine premedication likely contributed to early post-surfactant failures.
Collapse
Affiliation(s)
- J M B Pinheiro
- Department of Pediatrics, Albany Medical College, Albany, NY, USA
| | - Q Santana-Rivas
- Department of Pediatrics, Albany Medical College, Albany, NY, USA
| | - C Pezzano
- Department of Pediatrics, Albany Medical College, Albany, NY, USA.,Cardiorespiratory Services, Albany Medical Center, Albany, NY, USA
| |
Collapse
|
12
|
Bae CW, Chung SH, Choi YS. Development of a Synthetic Surfactant Using a Surfactant Protein-C Peptide Analog: In Vitro Studies of Surface Physical Properties. Yonsei Med J 2016; 57:203-8. [PMID: 26632402 PMCID: PMC4696954 DOI: 10.3349/ymj.2016.57.1.203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 09/01/2015] [Accepted: 10/01/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Pulmonary surfactant (PS) replacement has been the gold standard therapy for neonatal respiratory distress syndrome; however, almost all commercial PSs contain animal proteins. We prepared a synthetic PS by using a human surfactant protein (SP) analog and evaluated its in vitro properties. MATERIALS AND METHODS A peptide sequence (CPVHLKRLLLLLLLLLLLLLLLL) of human SP-C was chosen to develop the peptide analog (SPa-C). The new synthetic SP-C PS (sSP-C PS) was synthesized from SPa-C, dipalmitoyl phosphatidylcholine, phosphatidyl glycerol, and palmitic acid. Physical properties of the sSP-C PS were evaluated by measuring the maximum and minimum surface tensions (STs), surfactant spreading, and adsorption rate. In addition, we recorded an ST-area diagram. The data obtained on sSP-C PS were subsequently compared with those of purified natural bovine surfactant (PNBS), and the commercial product, Surfacten®. RESULTS The sSP-C PS and Surfacten® were found to have maximum ST values of 32-33 mN/m, whereas that of PNBS was much lower at 19 mN/m. The minimum ST values of all three products were less than 10 mN/m. The values that were measured for the equilibrium ST of rapidly spreading sSP-C PS, Surfacten®, and PNBS were 27, 27, and 24 mN/m, respectively. The surface adsorptions were found to be the same for all three PSs (20 mN/m). ST-area diagrams of sSP-C PS and Surfacten® revealed similar properties. CONCLUSION In an in vitro experiment, the physical properties exhibited by sSP-C PS were similar to those of Surfacten®. Further study is required to evaluate the in vivo efficacy.
Collapse
Affiliation(s)
- Chong Woo Bae
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea.
| | - Sung Hoon Chung
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yong Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| |
Collapse
|
13
|
Ballot DE, Chirwa T, Ramdin T, Chirwa L, Mare I, Davies VA, Cooper PA. Comparison of morbidity and mortality of very low birth weight infants in a Central Hospital in Johannesburg between 2006/2007 and 2013. BMC Pediatr 2015; 15:20. [PMID: 25885283 PMCID: PMC4373031 DOI: 10.1186/s12887-015-0337-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/19/2015] [Indexed: 02/04/2023] Open
Abstract
Background Health protocols need to be guided by current data on survival and benefits of interventions within the local context. Periodic clinical audits are required to inform and update health care protocols. This study aimed to review morbidity and mortality in very low birth weight (VLBW) infants in 2013 compared with similar data from 2006/2007. Methods We performed a retrospective review of patients’ records from a neonatal computer database for 562 VLBW infants. These neonates weighed between 500 and 1500 g at birth, and were admitted within 48 hours after birth between 01 January 2013 and 31 December 2013. Patients’ characteristics, complications of prematurity, and therapeutic interventions were compared with 2006/2007 data. Univariate analysis and multiple logistic regression were performed to establish significant associations of various factors with survival to discharge for 2013. Results Survival in 2013 was similar to that in 2006/2007 (73.4% vs 70.2%, p = 0.27). However, survival in neonates who weighed 750–900 g significantly improved from 20.4% in 2006/2007 to 52.4% in 2013 (p = 0.001). The use of nasal continuous positive airway pressure (NCPAP) increased from 20.3% to 62.9% and surfactant use increased from 19.2% to 65.5% between the two time periods (both p < 0.001). Antenatal care attendance improved from 54.4% to 70.6% (p = 0.001) and late onset sepsis (>72 hours after birth) increased from 12.5% to 19% (p = 0.006) between the two time periods. Other variables remained unchanged between 2006/2007 and 2013. The main determinants of survival to discharge in 2013 were birth weight (odds ratio 1.005, 95% confidence interval 1.003–1.0007, resuscitation at birth (2.673, 1.375–5.197), NCPAP (0.247, 0.109–0.560), necrotising enterocolitis (4.555, 1.659–12.51), and mode of delivery, including normal vaginal delivery (0.456, 0.231–0.903) and vaginal breech (0.069, 0.013–0.364). Conclusions There was a marked improvement in the survival of neonates weighing between 750 and 900 g at birth, most likely due to provision of surfactant and NCPAP. Provision of NCPAP, prevention of necrotising enterocolitis, and control of infection need to be prioritised in VLBW infants to improve their outcome.
Collapse
Affiliation(s)
- Daynia E Ballot
- Departments of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Tobias Chirwa
- Department of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Tanusha Ramdin
- Departments of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Lea Chirwa
- Departments of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Irma Mare
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Private Bag 3, Wits, 2050, Johannesburg, South Africa.
| | - Victor A Davies
- Departments of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Peter A Cooper
- Departments of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa.
| |
Collapse
|
14
|
Choi YS. The use of artificial pulmonary surfactant in neonatal respiratory distress. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2015. [DOI: 10.5124/jkma.2015.58.4.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| |
Collapse
|
15
|
Martin S, Duke T, Davis P. Efficacy and safety of bubble CPAP in neonatal care in low and middle income countries: a systematic review. Arch Dis Child Fetal Neonatal Ed 2014; 99:F495-504. [PMID: 25085942 DOI: 10.1136/archdischild-2013-305519] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Forty per cent of global child deaths occur in the neonatal period. Low and middle income countries need effective and simple methods to improve hospital-based neonatal care. Bubble continuous positive airway pressure (CPAP) may have a role in improving the quality of respiratory support in hospitals in low and middle income countries. AIM To examine the evidence for the efficacy and safety of bubble CPAP in neonates with respiratory distress in low and middle income settings. METHOD A systematic search (1946-March 2014) was performed of Pubmed, Ovid MEDLINE, Web of Science, Google Scholar and the references of relevant articles. Articles meeting inclusion criteria (CPAP for respiratory distress in infants <28 days of age in hospitals in low and middle income countries) were assessed using Grading of Recommendations, Assessment, Development and Evaluation and Newcastle-Ottawa Quality Assessment Scale methodology. Outcomes included need for mechanical ventilation, complications and mortality. RESULTS In three studies, the initial use of bubble CPAP compared with oxygen therapy, followed by mechanical ventilation if required, reduced the need for mechanical ventilation by 30%-50%. In another three trials comparing bubble CPAP with ventilator CPAP, mortality and complication rates were similar, while meta-analysis of CPAP failure in these same trials showed a lower failure rate in the bubble CPAP groups (p <0.003). CONCLUSIONS There is evidence that bubble CPAP is safe and reduces the need for mechanical ventilation. Further research into the efficacy of bubble CPAP in low-income and middle-income countries is needed.
Collapse
Affiliation(s)
- Simone Martin
- Neonatal Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Trevor Duke
- Department of Paediatrics, Centre for International Child Health, University of Melbourne MCRI, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Peter Davis
- Department of Neonatal Medicine, Royal Women's Hospital, Parkville, Victoria, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
16
|
Hendriks H, Kirsten GF, Voss M, Conradie H. Is continuous positive airway pressure a feasible treatment modality for neonates with respiratory distress syndrome in a rural district hospital? J Trop Pediatr 2014; 60:348-51. [PMID: 24876302 DOI: 10.1093/tropej/fmu025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess the feasibility of using nasal continuous positive airway pressure (nCPAP) in neonates with respiratory distress syndrome at district hospital level by assessing in-hospital survival rates and the impact on transfer rates. METHODS A prospective database was kept from 2008 to record the outcomes of neonates with mild to moderate respiratory distress treated with nCPAP at a South African rural district hospital. Transfer rates were compared for the two years before and after introduction of neonatal nCPAP using additional retrospective data from the Perinatal Problem Identification Programme (PPIP) for comparison. Outcomes for nCPAP neonates for the first 5 years after programme implementation are presented. RESULTS One hundred and twenty-eight babies were treated with nCPAP over the study period. Nine of 13 extremely low birth weight (<1000 g) babies died. Eighty-four (72.4%) of the babies weighing >1000 g were successfully treated, 16 (13.8%) were transferred after trial of nCPAP and 15 (12.9%) died in hospital. Most of the transferred babies and deaths had co-morbidities. There was a significant reduction in transfer rates of low birth weight babies from 21 to 7% in the first 2 years following the introduction of nCPAP. CONCLUSIONS nCPAP for neonatal respiratory distress at the district hospital is feasible, safe and offers the potential for significant cost savings.
Collapse
Affiliation(s)
- Hans Hendriks
- Ceres District Hospital, P/Bag x54, Ceres 8635, Republic of South Africa
| | - Gert F Kirsten
- Division of Neonatology, Department of Paediatrics, University of Stellenbosch and Tygerberg Children's Hospital Tygerberg 7505, Republic of South Africa
| | - Miranda Voss
- Ukwanda Rural Clinical School and Division of Community Health, University of Stellenbosch, Tygerberg 7505, Republic of South Africa
| | - Hofmeyer Conradie
- Ukwanda Rural Clinical School and Division of Family Medicine, University of Stellenbosch, Tygerberg 7505, Republic of South Africa
| |
Collapse
|
17
|
Kim SM, Park YJ, Chung SH, Choi YS, Kim CH, Bae CW. Early prophylactic versus late selective use of surfactant for respiratory distress syndrome in very preterm infants: a collaborative study of 53 multi-center trials in Korea. J Korean Med Sci 2014; 29:1126-31. [PMID: 25120324 PMCID: PMC4129206 DOI: 10.3346/jkms.2014.29.8.1126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 05/20/2014] [Indexed: 11/20/2022] Open
Abstract
Pulmonary surfactant (PS) therapy was proven to be highly successful for the treatment of respiratory distress syndrome in premature infants. As a results, early prophylactic (EP) PS therapy has been introduced recently in Europe, the US and Korea. However, no multi-center study was compared EP and late selective (LS) PS therapies in Korea. We performed a retrospective multi-center study to compare the outcomes of EP and LS PS therapies in very preterm infants. We analyzed clinical morbidity and mortality for 1,291 infants in 2010 (LS group) and 1,249 infants in 2011 (EP group); the infants were born <30 weeks of gestation and had birth weight ≤1,250 g, and were chosen from 53 neonatal intensive care units in Korea. Compared to the LS group (22.5%), the overall mortality was better in the EP group (19.9%) and there was no increased need for retreatment.There were additional benefits in the EP group such as fewer associated complications. To the best of knowledge, our study is the first nationwide Korean study to compare the outcomes of EP and LS therapies, and it provides evidences that EP PS therapy is important in very preterm infants to improve for survival and reduce morbidities.
Collapse
Affiliation(s)
- Sung Mi Kim
- Department of Pediatrics, Busan St. Mary's Medical Center, Busan, Korea
| | - Young Jin Park
- Department of Pediatrics, Busan St. Mary's Medical Center, Busan, Korea
| | - Sung-Hoon Chung
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Chang Hoon Kim
- Department of Preventive Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Chong-Woo Bae
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| |
Collapse
|
18
|
Lopez E, Gascoin G, Flamant C, Merhi M, Tourneux P, Baud O. Exogenous surfactant therapy in 2013: what is next? Who, when and how should we treat newborn infants in the future? BMC Pediatr 2013; 13:165. [PMID: 24112693 PMCID: PMC3851818 DOI: 10.1186/1471-2431-13-165] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 09/19/2013] [Indexed: 11/10/2022] Open
Abstract
Background Surfactant therapy is one of the few treatments that have dramatically changed clinical practice in neonatology. In addition to respiratory distress syndrome (RDS), surfactant deficiency is observed in many other clinical situations in term and preterm infants, raising several questions regarding the use of surfactant therapy. Objectives This review focuses on several points of interest, including some controversial or confusing topics being faced by clinicians together with emerging or innovative concepts and techniques, according to the state of the art and the published literature as of 2013. Surfactant therapy has primarily focused on RDS in the preterm newborn. However, whether this treatment would be of benefit to a more heterogeneous population of infants with lung diseases other than RDS needs to be determined. Early trials have highlighted the benefits of prophylactic surfactant administration to newborns judged to be at risk of developing RDS. In preterm newborns that have undergone prenatal lung maturation with steroids and early treatment with continuous positive airway pressure (CPAP), the criteria for surfactant administration, including the optimal time and the severity of RDS, are still under discussion. Tracheal intubation is no longer systematically done for surfactant administration to newborns. Alternative modes of surfactant administration, including minimally-invasive and aerosolized delivery, could thus allow this treatment to be used in cases of RDS in unstable preterm newborns, in whom the tracheal intubation procedure still poses an ethical and medical challenge. Conclusion The optimization of the uses and methods of surfactant administration will be one of the most important challenges in neonatal intensive care in the years to come.
Collapse
Affiliation(s)
- Emmanuel Lopez
- Réanimation et Pédiatrie Néonatales, Groupe Hospitalier Robert Debré, APHP, 48 Bd Sérurier, Paris, 75019, France.
| | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
Surfactant replacement in preterm infants with respiratory distress syndrome (RDS) has been a major therapeutic breakthrough and the most intensively studied intervention in neonatal medicine. Surfactant whether given prophylactically in the delivery room or in babies with established RDS reduces the severity of RDS, the incidence of air leaks and pneumothorax and, most importantly, neonatal death. Many randomized controlled trials have explored different strategies to optimize the effect of surfactant administration and have further improved neonatal outcome. Whenever indicated, surfactant should be administered as early as possible in the course of the RDS.
Collapse
|