Dargaville, PA and Aiyappan, A and Cornelius, A and Williams, C and De Paoli, AG, Preliminary evaluation of a new technique of minimally invasive surfactant therapy, Archives of Disease in Childhood-fetal and Neonatal Edition, 96, (4) pp. F243-F248. ISSN 1359-2998 (2011) [Refereed Article]
Copyright 2011 BMJ Publishing Group Ltd
Objective: To investigate a method of minimally invasive surfactant therapy (MIST) to be used in spontaneously breathing preterm infants on continuous positive airway pressure (CPAP), evaluating the feasibility of the technique and the therapeutic benefit after MIST.
Design: Non-randomised feasibility study.
Setting: Tertiary neonatal intensive care unit.
Patients and interventions: Study subjects were preterm infants with respiratory distress supported with CPAP, with early enrolment of 25-28-week infants (n=11) at any CPAP pressure and fractional inspired O2 concentration (FiO2), and enrolment of 29-34-week infants (n=14)at CPAP pressure ≥ 7 cm H2O and FiO2 ≥ 0.35. Without premedication, a 16 gauge vascular catheter was inserted through the vocal cords under direct vision. Porcine surfactant (~ 100 mg/kg) was then instilled, followed by reinstitution of CPAP.
Measurements and results: Respiratory indices were documented for 4 h following MIST, and neonatal outcomes ascertained. In all cases, surfactant was successfully administered and CPAP re-established. Coughing (32%) and bradycardia (44%) were transiently noted, and 44% received positive pressure inflations. There was a clear surfactant effect, with lower FiO2 after MIST (pre-MIST: 0.39 ± 0.092 (mean ± SD); 4 h: 0.26 ± 0.093; p < 0.01), and a modest reduction in CPAP pressure. Adverse outcomes were few: intubation within 72 h (n=3), pneumothorax (n=1), chronic lung disease (n=3) and death (n=1), all in the 25-28-week group. Outcome was otherwise favourable in both gestation groups, with a trend towards reduction in intubation in the first 72 h in the 25-28-week infants compared with historical controls.Conclusions: Surfactant can be effectively delivered via a vascular catheter, and this method of MIST deserves further investigation.
|Item Type:||Refereed Article|
|Keywords:||preterm infants, spontaneous breathing, respiratory distress, minimally invasive surfactant therapy|
|Research Division:||Biological Sciences|
|Research Group:||Biochemistry and Cell Biology|
|Research Field:||Proteomics and Intermolecular Interactions (excl. Medical Proteomics)|
|Objective Group:||Clinical Health (Organs, Diseases and Abnormal Conditions)|
|Objective Field:||Infectious Diseases|
|Author:||Dargaville, PA (Professor Peter Dargaville)|
|Author:||Cornelius, A (Dr Anita Cornelius)|
|Author:||De Paoli, AG (Dr Tony De Paoli)|
|Web of Science® Times Cited:||57|
|Deposited By:||Menzies Institute for Medical Research|
|Downloads:||3 View Download Statistics|
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