Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
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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

  • Seo, Moon Young (Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Shim, Gyu Hong (Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Chey, Myoung Jae (Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine)
  • Received : 2018.05.17
  • Accepted : 2018.08.16
  • Published : 2018.08.31
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Abstract

Purpose: Minimally invasive surfactant therapy (MIST) is currently used as a method of surfactant replacement therapy (SRT) for the treatment of respiratory distress syndrome (RDS) in preterm infants with a gestational age of less than 30 weeks. However, few studies have been conducted on MIST in neonates with a gestational age of 30 weeks or more. In this study, we compared MIST with endotracheal intubation as a rescue SRT for spontaneously breathing neonates with a gestational age of 30 weeks or more who were diagnosed with RDS. Methods: We investigated the clinical characteristics of spontaneously breathing neonates admitted to the neonatal intensive care unit of the Inje University Sanggye Paik Hospital from January 1, 2014 to December 31, 2016. These neonates were born at a gestational age of 30 weeks or more and were diagnosed with RDS. The neonates who were administered surfactant by MIST were categorized into the MIST group (n=16) and those who underwent endotracheal intubation were categorized into the control group (n=45). Thereafter, the clinical characteristics between the groups were compared. Results: Compared to the control group, the MIST group was less likely to require mechanical ventilation within 72 hours (P<0.001). The frequency of bradycardia during SRT was also low in the MIST group (P=0.033). Conclusion: MIST is considered relatively feasible and safe for treating RDS for reducing the need for mechanical ventilation and decreasing the occurrence of bradycardia during surfactant administration in neonates with a gestational age of 30 weeks or more.

Keywords

References

  1. Speer CP. Neonatal respiratory distress syndrome: an inflammatory disease? Neonatology 2011;99:316-9. https://doi.org/10.1159/000326619
  2. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European consensus guidelines on the management of respiratory distress syndrome: 2016 update. Neonatology 2017;111:107-25. https://doi.org/10.1159/000448985
  3. 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
  4. 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
  5. 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
  6. Venkatesh V, Ponnusamy V, Anandaraj J, Chaudhary R, Malviya M, Clarke P, et al. Endotracheal intubation in a neonatal population remains associated with a high risk of adverse events. Eur J Pediatr 2011;170:223-7. https://doi.org/10.1007/s00431-010-1290-8
  7. Nilsson R, Grossmann G, Robertson B. Bronchiolar epithelial lesions induced in the premature rabbit neonate by short periods of artificial ventilation. Acta Pathol Microbiol Scand A 1980;88:359-67.
  8. Kolatat T, Aunganon K, Yosthiem P. Airway complications in neonates who received mechanical ventilation. J Med Assoc Thai 2002;85 Suppl 2:S455-62.
  9. Allen KA. Premedication for neonatal intubation: which medications are recommended and why. Adv Neonatal Care 2012;12:107-11. https://doi.org/10.1097/ANC.0b013e31824c1583
  10. Shim GH. Update of minimally invasive surfactant therapy. Korean J Pediatr 2017;60:273-81. https://doi.org/10.3345/kjp.2017.60.9.273
  11. 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 openlabel, randomised, controlled trial. Lancet 2011;378:1627-34. https://doi.org/10.1016/S0140-6736(11)60986-0
  12. Gortner L, Bartmann P, Pohlandt F, Bernsau U, Porz F, Hellwege HH, et al. Early treatment of respiratory distress syndrome with bovine surfactant in very preterm infants: a multicenter controlled clinical trial. Pediatr Pulmonol 1992;14:4-9.
  13. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163:1723-9. https://doi.org/10.1164/ajrccm.163.7.2011060
  14. Kliegman RM, Walsh MC. Neonatal necrotizing enterocolitis: pathogenesis, classification, and spectrum of illness. Curr Probl Pediatr 1987;17:213-88.
  15. International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 2005;123:991-9. https://doi.org/10.1001/archopht.123.7.991
  16. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978;92:529-34. https://doi.org/10.1016/S0022-3476(78)80282-0
  17. Aldana-Aguirre JC, Pinto M, Featherstone RM, Kumar M. Less invasive surfactant administration versus intubation for surfactant delivery in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2017;102:F17-23. https://doi.org/10.1136/archdischild-2015-310299
  18. Lopez E, Gascoin G, Flamant C, Merhi M, Tourneux P, Baud O, et al. 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. https://doi.org/10.1186/1471-2431-13-165
  19. Bohlin K, Bouhafs RK, Jarstrand C, Curstedt T, Blennow M, Robertson B. Spontaneous breathing or mechanical ventilation alters lung compliance and tissue association of exogenous surfactant in preterm newborn rabbits. Pediatr Res 2005;57:624-30. https://doi.org/10.1203/01.PDR.0000156502.84909.BC
  20. 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
  21. 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
  22. Tomar RS, Ghuliani R, Yadav D. Effect of surfactant therapy using orogastric tube for tracheal catheterization in preterm newborns with respiratory distress. Indian J Pediatr 2017;84:257-61. https://doi.org/10.1007/s12098-016-2278-9
  23. Jones P, Dauger S, Peters MJ. Bradycardia during critical care intubation: mechanisms, significance and atropine. Arch Dis Child 2012;97:139-44. https://doi.org/10.1136/adc.2010.210518
  24. Kumar P, Denson SE, Mancuso TJ; Committee on Fetus and Newborn, Section on Anesthesiology and Pain Medicine. Premedication for nonemergency endotracheal intubation in the neonate. Pediatrics 2010;125:608-15. https://doi.org/10.1542/peds.2009-2863
  25. 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
  26. 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
  27. Dargaville PA, Ali SKM, Jackson HD, Williams C, De Paoli AG. Impact of minimally invasive surfactant therapy in preterm infants at 29-32 weeks gestation. Neonatology 2018;113:7-14. https://doi.org/10.1159/000480066

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