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Effect of minimally invasive surfactant therapy vs sham treatment on death or bronchopulmonary dysplasia in preterm infants with respiratory distress Syndrome: The OPTIMIST-A Randomized Clinical Trial

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Dargaville, PA and Kamlin, COF and Orsini, F and Wang, X and Kanmaz Kutman, HG and Cetinkaya, M and Kornhauser-Cerar, L and Derrick, M and Ozkan, H and Hulzebos, CV and Schmolzer, GM and Aiyappan, A and Lemyre, B and Kuo, S and Rajadurai, VS and O'Shea, J and Biniwale, M and Ramanathan, R and Kushnir, R and Bader, D and Thomas, MR and Chakraborty, M and Buksh, MJ and Bhatia, R and Sullivan, CL and Shinwell, ES and Dyson, A and Barker, DP and Kugelman, A and Donovan, TJ and Tauscher, MK and Murthy, V and Ali, SKM and Yossuck, P and Clark, HW and Soll, RF and Carlin, JB and Davis, PG, OPTIMIST-A Trial Investigators, Effect of minimally invasive surfactant therapy vs sham treatment on death or bronchopulmonary dysplasia in preterm infants with respiratory distress Syndrome: The OPTIMIST-A Randomized Clinical Trial, JAMA - Journal of the American Medical Association, 326, (24) pp. 2478-2487. ISSN 0098-7484 (2021) [Refereed Article]


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DOI: doi:10.1001/jama.2021.21892

Abstract

Importance: The benefits of surfactant administration via a thin catheter (minimally invasive surfactant therapy [MIST]) in preterm infants with respiratory distress syndrome are uncertain.

Objective: To examine the effect of selective application of MIST at a low fraction of inspired oxygen threshold on survival without bronchopulmonary dysplasia (BPD).

Design, setting, and participants:Randomized clinical trial including 485 preterm infants with a gestational age of 25 to 28 weeks who were supported with continuous positive airway pressure (CPAP) and required a fraction of inspired oxygen of 0.30 or greater within 6 hours of birth. The trial was conducted at 33 tertiary-level neonatal intensive care units around the world, with blinding of the clinicians and outcome assessors. Enrollment took place between December 16, 2011, and March 26, 2020; follow-up was completed on December 2, 2020.

Interventions: Infants were randomized to the MIST group (n = 241) and received exogenous surfactant (200 mg/kg of poractant alfa) via a thin catheter or to the control group (n = 244) and received a sham (control) treatment; CPAP was continued thereafter in both groups unless specified intubation criteria were met.

Main outcomes and measures: The primary outcome was the composite of death or physiological BPD assessed at 36 weeks' postmenstrual age. The components of the primary outcome (death prior to 36 weeks' postmenstrual age and BPD at 36 weeks' postmenstrual age) also were considered separately.

Results: Among the 485 infants randomized (median gestational age, 27.3 weeks; 241 [49.7%] female), all completed follow-up. Death or BPD occurred in 105 infants (43.6%) in the MIST group and 121 (49.6%) in the control group (risk difference [RD], -6.3% [95% CI, -14.2% to 1.6%]; relative risk [RR], 0.87 [95% CI, 0.74 to 1.03]; P = .10). Incidence of death before 36 weeks' postmenstrual age did not differ significantly between groups (24 [10.0%] in MIST vs 19 [7.8%] in control; RD, 2.1% [95% CI, -3.6% to 7.8%]; RR, 1.27 [95% CI, 0.63 to 2.57]; P = .51), but incidence of BPD in survivors to 36 weeks' postmenstrual age was lower in the MIST group (81/217 [37.3%] vs 102/225 [45.3%] in the control group; RD, -7.8% [95% CI, -14.9% to -0.7%]; RR, 0.83 [95% CI, 0.70 to 0.98]; P = .03). Serious adverse events occurred in 10.3% of infants in the MIST group and 11.1% in the control group.

Conclusions and relevance: Among preterm infants with respiratory distress syndrome supported with CPAP, minimally invasive surfactant therapy compared with sham (control) treatment did not significantly reduce the incidence of the composite outcome of death or bronchopulmonary dysplasia at 36 weeks' postmenstrual age. However, given the statistical uncertainty reflected in the 95% CI, a clinically important effect cannot be excluded.

Item Details

Item Type:Refereed Article
Research Division:Biomedical and Clinical Sciences
Research Group:Paediatrics
Research Field:Neonatology
Objective Division:Health
Objective Group:Clinical health
Objective Field:Treatment of human diseases and conditions
UTAS Author:Dargaville, PA (Professor Peter Dargaville)
ID Code:152215
Year Published:2021
Web of Science® Times Cited:18
Deposited By:Menzies Institute for Medical Research
Deposited On:2022-08-15
Last Modified:2022-08-25
Downloads:0

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