Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Update of minimally invasive surfactant therapy

  • Shim, Gyu-Hong (Department of Pediatrics, Inje University Busan Paik Hospital)
  • Received : 2017.04.19
  • Accepted : 2017.08.18
  • Published : 2017.09.15
Download PDF
⟨ Previous Next ⟩

Abstract

To date, preterm infants with respiratory distress syndrome (RDS) after birth have been managed with a combination of endotracheal intubation, surfactant instillation, and mechanical ventilation. It is now recognized that noninvasive ventilation (NIV) such as nasal continuous positive airway pressure (CPAP) in preterm infants is a reasonable alternative to elective intubation after birth. Recently, a meta-analysis of large controlled trials comparing conventional methods and nasal CPAP suggested that CPAP decreased the risk of the combined outcome of bronchopulmonary dysplasia or death. Since then, the use of NIV as primary therapy for preterm infants has increased, but when and how to give exogenous surfactant remains unclear. Overcoming this problem, minimally invasive surfactant therapy (MIST) allows spontaneously breathing neonates to remain on CPAP in the first week after birth. MIST has included administration of exogenous surfactant by intrapharyngeal instillation, nebulization, a laryngeal mask, and a thin catheter. In recent clinical trials, surfactant delivery via a thin catheter was found to reduce the need for subsequent endotracheal intubation and mechanical ventilation, and improves short-term respiratory outcomes. There is also growing evidence for MIST as an alternative to the INSURE (intubation-surfactant-extubation) procedure in spontaneously breathing preterm infants with RDS. In conclusion, MIST is gentle, safe, feasible, and effective in preterm infants, and is widely used for surfactant administration with noninvasive respiratory support by neonatologists. However, further studies are needed to resolve uncertainties in the MIST method, including infant selection, optimal surfactant dosage and administration method, and need for sedation.

Keywords

References

  1. Guttentag S, Foster CD. Update in surfactant therapy. NeoReviews 2011;12:e625-34. https://doi.org/10.1542/neo.12-11-e625
  2. Seger N, Soll R. Animal derived surfactant extract for treatment of respiratory distress syndrome. Cochrane Database Syst Rev 2009;(2):CD007836.
  3. Yost CC, Soll RF. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev 2000;(2):CD001456.
  4. Soll RF, Morley CJ. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2001;(2):CD000510.
  5. Iliodromiti Z, Zygouris D, Sifakis S, Pappa KI, Tsikouras P, Salakos N, et al. Acute lung injury in preterm fetuses and neonates: mechanisms and molecular pathways. J Matern Fetal Neonatal Med 2013;26:1696-704. https://doi.org/10.3109/14767058.2013.798284
  6. 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. https://doi.org/10.1056/NEJMoa0911783
  7. 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. https://doi.org/10.1056/NEJMoa072788
  8. 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:e1069-76. https://doi.org/10.1542/peds.2010-3848
  9. Chowdhury O, Wedderburn CJ, Duffy D, Greenough A. CPAP review. Eur J Pediatr 2012;171:1441-8. https://doi.org/10.1007/s00431-011-1648-6
  10. Hillman N, Jobe AH. Noninvasive strategies for management of respiratory problems in neonates. NeoReviews 2013;14:e227-36. https://doi.org/10.1542/neo.14-5-e227
  11. Schmolzer GM, Kumar M, Pichler G, Aziz K, O'Reilly M, Cheung PY. Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis. BMJ 2013;347:f5980. https://doi.org/10.1136/bmj.f5980
  12. Rojas-Reyes MX, Morley CJ, Soll R. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2012;(3):CD000510.
  13. Fischer HS, Buhrer C. Avoiding endotracheal ventilation to prevent bronchopulmonary dysplasia: a meta-analysis. Pediatrics 2013;132:e1351-60. https://doi.org/10.1542/peds.2013-1880
  14. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants-- 2013 update. Neonatology 2013;103:353-68. https://doi.org/10.1159/000349928
  15. Committee on Fetus and Newborn; American Academy of Pediatrics. Respiratory support in preterm infants at birth. Pediatrics 2014;133:171-4. https://doi.org/10.1542/peds.2013-3442
  16. Aguar M, Vento M, Dargaville PA. Minimally invasive surfactant therapy: an update. NeoReviews 2014;15:e275-85. https://doi.org/10.1542/neo.15-7-e275
  17. Verder H, Robertson B, Greisen G, Ebbesen F, Albertsen P, Lundstrom K, et al. Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. Danish-Swedish Multicenter Study Group. N Engl J Med 1994;331:1051-5. https://doi.org/10.1056/NEJM199410203311603
  18. Verder H, Albertsen P, Ebbesen F, Greisen G, Robertson B, Bertelsen A, et al. Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks' gestation. Pediatrics 1999;103:E24. https://doi.org/10.1542/peds.103.2.e24
  19. Bohlin K, Henckel E, Blennow M. International perspectives: Surfactant without assisted ventilation: the Scandinavian perspective. NeoReviews 2008;9:e555-61. https://doi.org/10.1542/neo.9-12-e555
  20. Suresh GK, Soll RF. Overview of surfactant replacement trials. J Perinatol 2005;25 Suppl 2:S40-4. https://doi.org/10.1038/sj.jp.7211320
  21. Escobedo MB, Gunkel JH, Kennedy KA, Shattuck KE, Sanchez PJ, Seidner S, et al. Early surfactant for neonates with mild to moderate respiratory distress syndrome: a multicenter, randomized trial. J Pediatr 2004;144:804-8.
  22. Reininger A, Khalak R, Kendig JW, Ryan RM, Stevens TP, Reubens L, et al. Surfactant administration by transient intubation in infants 29 to 35 weeks' gestation with respiratory distress syndrome decreases the likelihood of later mechanical ventilation: a randomized controlled trial. J Perinatol 2005;25:703-8. https://doi.org/10.1038/sj.jp.7211381
  23. Sandri F, Plavka 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. https://doi.org/10.1542/peds.2009-2131
  24. Klebermass-Schrehof K, Wald M, Schwindt J, Grill A, Prusa AR, Haiden N, et al. Less invasive surfactant administration in extremely preterm infants: impact on mortality and morbidity. Neonatology 2013;103:252-8. https://doi.org/10.1159/000346521
  25. Kattwinkel J, Robinson M, Bloom BT, Delmore P, Ferguson JE. Technique for intrapartum administration of surfactant without requirement for an endotracheal tube. J Perinatol 2004;24:360-5. https://doi.org/10.1038/sj.jp.7211103
  26. Berggren E, Liljedahl M, Winbladh B, Andreasson B, Curstedt T, Robertson B, et al. Pilot study of nebulized surfactant therapy for neonatal respiratory distress syndrome. Acta Paediatr 2000;89:460-4. https://doi.org/10.1111/j.1651-2227.2000.tb00084.x
  27. Trevisanuto D, Grazzina N, Ferrarese P, Micaglio M, Verghese C, Zanardo V. Laryngeal mask airway used as a delivery conduit for the administration of surfactant to preterm infants with respiratory distress syndrome. Biol Neonate 2005;87:217-20. https://doi.org/10.1159/000083370
  28. Kribs A, Pillekamp F, Hunseler C, Vierzig A, Roth B. Early administration of surfactant in spontaneous breathing with nCPAP: feasibility and outcome in extremely premature infants (postmenstrual age https://doi.org/10.1111/j.1460-9592.2006.02126.x
  29. Kribs A, Vierzig A, Hunseler C, Eifinger F, Welzing L, Stutzer H, et al. Early surfactant in spontaneously breathing with nCPAP in ELBW infants: a single centre four year experience. Acta Paediatr 2008;97:293-8. https://doi.org/10.1111/j.1651-2227.2007.00617.x
  30. Dargaville PA. Innovation in surfactant therapy I: surfactant lavage and surfactant administration by fluid bolus using minimally invasive techniques. Neonatology 2012;101:326-36. https://doi.org/10.1159/000337346
  31. More K, Sakhuja P, Shah PS. Minimally invasive surfactant administration in preterm infants: a meta-narrative review. JAMA Pediatr 2014;168:901-8. https://doi.org/10.1001/jamapediatrics.2014.1148
  32. Ten centre trial of artificial surfactant (artificial lung expanding compound) in very premature babies. Ten Centre Study Group. Br Med J (Clin Res Ed) 1987;294:991-6. https://doi.org/10.1136/bmj.294.6578.991
  33. Dambeanu JM, Parmigiani S, Marinescu B, Bevilacqua G. Use of surfactant for prevention of respiratory distress syndrome in newborn infants in spontaneous breathing. A randomized multicentre clinical pilot-study. Acta Biomed Ateneo Parmense 1997;68 Suppl 1:39-45.
  34. Jorch G, Hartl H, Roth B, Kribs A, Gortner L, Schaible T, et al. Surfactant aerosol treatment of respiratory distress syndrome in spontaneously breathing premature infants. Pediatr Pulmonol 1997;24:222-4. https://doi.org/10.1002/(SICI)1099-0496(199709)24:3<222::AID-PPUL9>3.0.CO;2-O
  35. Arroe M, Pedersen-Bjergaard L, Albertsen P, Bode S, Greisen G, Jonsbo F, et al. Inhalation of aerosolized surfactant (Exosurf1) to neonates treated with nasal continuous positive airway pressure. Prenat Neonat Med 1998;3:346-52.
  36. Finer NN, Merritt TA, Bernstein G, Job L, Mazela J, Segal R. An open label, pilot study of $Aerosurf^{(R)}$ combined with nCPAP to prevent RDS in preterm neonates. J Aerosol Med Pulm Drug Deliv 2010;23:303-9. https://doi.org/10.1089/jamp.2009.0758
  37. Minocchieri S, Berry CA, Pillow J. Nebulized surfactant for treatment of respiratory distress in the first hours of life: the CureNeb study [abstract]. In: Annual Meeting of the Pediatric Academic Societies 2013; 2013 May 4-7; Washington, DC, USA. Session 3500.
  38. Brimacombe J, Gandini D, Keller C. The laryngeal mask airway for administration of surfactant in two neonates with respiratory distress syndrome. Paediatr Anaesth 2004;14:188-90. https://doi.org/10.1046/j.1460-9592.2003.01173.x
  39. Micaglio M, Zanardo V, Ori C, Parotto M, Doglioni N, Trevisanuto D. ProSeal LMA for surfactant administration. Paediatr Anaesth 2008;18:91-2.
  40. Barbosa RF, Marcatto Jde O, Silva AC, Silva YP. ProSealTM laryngeal mask airway for surfactant administration in the treatment of respiratory distress syndrome in a premature infant. Rev Bras Ter Intensiva 2012;24:207-10. https://doi.org/10.1590/S0103-507X2012000200018
  41. Attridge JT, Stewart C, Stukenborg GJ, Kattwinkel J. Administration of rescue surfactant by laryngeal mask airway: lessons from a pilot trial. Am J Perinatol 2013;30:201-6.
  42. Sadeghnia A, Tanhaei M, Mohammadizadeh M, Nemati M. A comparison of surfactant administration through i-gel and ET-tube in the treatment of respiratory distress syndrome in newborns weighing more than 2000 grams. Adv Biomed Res 2014;3:160. https://doi.org/10.4103/2277-9175.137875
  43. Pinheiro JM, Santana-Rivas Q, Pezzano C. Randomized trial of laryngeal mask airway versus endotracheal intubation for surfactant delivery. J Perinatol 2016;36:196-201. https://doi.org/10.1038/jp.2015.177
  44. Verder H, Agertoft L, Albertsen P, Christensen NC, Curstedt T, Ebbesen F, et al. 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.
  45. Kribs A, Hartel C, Kattner E, Vochem M, Kuster H, Moller J, et al. Surfactant without intubation in preterm infants with respiratory distress: first multi-center data. Klin Padiatr 2010;222:13-7. https://doi.org/10.1055/s-0029-1241867
  46. Gopel W, Kribs A, Ziegler A, Laux R, 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. https://doi.org/10.1016/S0140-6736(11)60986-0
  47. Dargaville PA, Aiyappan A, Cornelius A, Williams C, De Paoli AG. Preliminary evaluation of a new technique of minimally invasive surfactant therapy. Arch Dis Child Fetal Neonatal Ed 2011;96:F243-8. https://doi.org/10.1136/adc.2010.192518
  48. Dargaville PA, Aiyappan A, De Paoli AG, Kuschel CA, Kamlin CO, Carlin JB, et al. Minimally-invasive surfactant therapy in preterm infants on continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed 2013;98:F122-6. https://doi.org/10.1136/archdischild-2011-301314
  49. Mehler K, Grimme J, Abele J, Huenseler C, Roth B, Kribs A. Outcome of extremely low gestational age newborns after introduction of a revised protocol to assist preterm infants in their transition to extrauterine life. Acta Paediatr 2012;101:1232-9. https://doi.org/10.1111/apa.12015
  50. Kanmaz HG, Erdeve O, Canpolat FE, Mutlu B, Dilmen U. Surfactant administration via thin catheter during spontaneous breathing: randomized controlled trial. Pediatrics 2013;131:e502-9. https://doi.org/10.1542/peds.2012-0603
  51. 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.
  52. 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 2014;103:e229-33. https://doi.org/10.1111/apa.12611
  53. Kribs A, Roll C, Gopel W, Wieg C, Groneck P, Laux R, et al. Nonintubated surfactant application vs conventional therapy in extremely preterm infants: a randomized clinical trial. JAMA Pediatr 2015;169:723-30. https://doi.org/10.1001/jamapediatrics.2015.0504
  54. 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. https://doi.org/10.4103/2279-042X.150053
  55. 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;15:21. https://doi.org/10.1186/s12887-015-0342-7
  56. Krajewski P, Chudzik A, Strzalko-Gloskowska B, Gorska M, Kmiecik M, Wieckowska K, et al. Surfactant administration without intubation in preterm infants with respiratory distress syndrome--our experiences. J Matern Fetal Neonatal Med 2015;28:1161-4. https://doi.org/10.3109/14767058.2014.947571
  57. Gopel W, Kribs A, Hartel C, Avenarius S, Teig N, Groneck P, et al. Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants. Acta Paediatr 2015;104:241-6. https://doi.org/10.1111/apa.12883
  58. Canals Candela FJ, Vizcaino Diaz C, Ferrandez Berenguer MJ, Serrano Robles MI, Vazquez Gomis C, Quiles Dura JL. Surfactant replacement therapy with a minimally invasive technique: Experience in a tertiary hospital. An Pediatr (Barc) 2016;84:79-84. https://doi.org/10.1016/j.anpedi.2015.04.013
  59. Enhorning G, Robertson B. Lung expansion in the premature rabbit fetus after tracheal deposition of surfactant. Pediatrics 1972;50:58-66.
  60. Abdel-Latif ME, Osborn DA. Pharyngeal instillation of surfactant before the first breath for prevention of morbidity and mortality in preterm infants at risk of respiratory distress syndrome. Cochrane Database Syst Rev 2011;(3):CD008311.
  61. Kribs A. Minimally invasive surfactant therapy and noninvasive respiratory support. Clin Perinatol 2016;43:755-71. https://doi.org/10.1016/j.clp.2016.07.010
  62. Fok TF, al-Essa M, Dolovich M, Rasid F, Kirpalani H. Nebulisation of surfactants in an animal model of neonatal respiratory distress. Arch Dis Child Fetal Neonatal Ed 1998;78:F3-9. https://doi.org/10.1136/fn.78.1.F3
  63. Pillow JJ, Minocchieri S. Innovation in surfactant therapy II: surfactant administration by aerosolization. Neonatology 2012;101:337-44. https://doi.org/10.1159/000337354
  64. Dargaville PA, Kamlin CO, De Paoli AG, Carlin JB, Orsini F, Soll RF, et al. The OPTIMIST-A trial: evaluation of minimally-invasive surfactant therapy in preterm infants 25-28 weeks gestation. BMC Pediatr 2014;14:213. https://doi.org/10.1186/1471-2431-14-213
  65. Bahadue FL, Soll R. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev 2012;11:CD001456.
  66. Klotz D, Porcaro U, Fleck T, Fuchs H. European perspective on less invasive surfactant administration-a survey. Eur J Pediatr 2017;176:147-54. https://doi.org/10.1007/s00431-016-2812-9
  67. Porath M, Korp L, Wendrich D, Dlugay V, Roth B, Kribs A. Surfactant in spontaneous breathing with nCPAP: neurodevelopmental outcome at early school age of infants ${\leq}$27 weeks. Acta Paediatr 2011;100:352-9. https://doi.org/10.1111/j.1651-2227.2010.02068.x
  68. Teig N, Weitkamper A, Rothermel J, Bigge N, Lilienthal E, Rossler L, et al. Observational Study on Less Invasive Surfactant Administration (LISA) in Preterm Infants<29 Weeks: Short and Long-term Outcomes. Z Geburtshilfe Neonatol 2015;219:266-73. https://doi.org/10.1055/s-0035-1547295

Cited by

  1. Clinical Outcomes of Minimally Invasive Surfactant Therapy via Tracheal Catheterization in Neonates with a Gestational Age of 30 Weeks or More Diagnosed with Respiratory Distress Syndrome vol.25, pp.3, 2017, https://doi.org/10.5385/nm.2018.25.3.109
  2. Should Minimally Invasive Surfactant Therapy be a Must in Neonatal Intensive Care Units? Pilot Report of Initial Cases in Dubai vol.10, pp.10, 2017, https://doi.org/10.7759/cureus.3495
  3. High-volume surfactant administration using a minimally invasive technique: Experience from a Canadian Neonatal Intensive Care Unit vol.24, pp.5, 2017, https://doi.org/10.1093/pch/pxy162
  4. Eliminating Risk of Intubation in Very Preterm Infants with Noninvasive Cardiorespiratory Support in the Delivery Room and Neonatal Intensive Care Unit vol.2019, pp.None, 2017, https://doi.org/10.1155/2019/5984305
  5. Feasibility and Functional Evaluation of Noninvasive Ventilation Capable Equipment from the Delivery Room to Neonatal Intensive Care Unit: A Bench Study vol.30, pp.2, 2019, https://doi.org/10.14734/pn.2019.30.2.83
  6. Effects of less invasive surfactant administration (LISA) via a gastric tube on the treatment of respiratory distress syndrome in premature infants aged 32 to 36 weeks vol.99, pp.9, 2017, https://doi.org/10.1097/md.0000000000019216
  7. Aerosolized Calfactant for Newborns With Respiratory Distress: A Randomized Trial vol.146, pp.5, 2020, https://doi.org/10.1542/peds.2019-3967
  8. Accuracy of lung ultrasonography in the diagnosis of respiratory distress syndrome in newborns vol.34, pp.2, 2017, https://doi.org/10.1080/14767058.2019.1605350
  9. Comparison of three natural surfactants according to lung ultrasonography scores in newborns with respiratory distress syndrome vol.34, pp.10, 2017, https://doi.org/10.1080/14767058.2019.1643313