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Minimally-invasive surfactant therapy in preterm infants on continuous positive airway pressure
Dargaville, PA and Aiyappan, A and De Paoli, AG and Kuschel, CA and Kamlin, COF and Carlin, JB and Davis, PG, Minimally-invasive surfactant therapy in preterm infants on continuous positive airway pressure, ADC Fetal and Neonatal, 98, (2) pp. F122-126. ISSN 1468-2052 (2013) [Refereed Article]
Copyright 2013 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health
Objective: To evaluate the applicability and potential effectiveness of a technique of minimally-invasive surfactant therapy (MIST) in preterm infants on continuous positive airway pressure (CPAP).
Methods: An open feasibility study of MIST was conducted at two sites. Infants were eligible for MIST if needing CPAP pressure ≥7 cm H2O and FiO2 ≥0.3 (25–28 weeks gestation, n=38) or ≥0.35 (29–32 weeks, n=23). Without premedication, a narrow-bore catheter was inserted through the vocal cords under direct vision. Surfactant (100 or 200 mg/kg Curosurf ) was then instilled, followed by reinstitution of CPAP. Outcomes were compared between surfactant-treated infants and historical controls achieving the same CPAP and FiO2 thresholds.
Results: Surfactant was successfully administered via MIST in all cases, with a rapid and sustained reduction in FiO2 thereafter. For infants at 25–28 weeks gestation, need for intubation <72 h was diminished after MIST compared with controls (32% vs 68%; OR 0.21, 95% CI 0.083 to 0.55), with a similar trend at 29–32 weeks (22% vs 45%; OR 0.34, 95% CI 0.11 to 1.1). Duration of ventilation and incidence of bronchopulmonary dysplasia were similar, but infants receiving MIST had a shorter duration of oxygen therapy.
Conclusion: Surfactant delivery via a narrow-bore tracheal catheter is feasible and potentially effective, and deserves further investigation in clinical trials.
|Item Type:||Refereed Article|
|Research Division:||Biomedical and Clinical Sciences|
|Research Field:||Paediatrics not elsewhere classified|
|Objective Group:||Clinical health|
|Objective Field:||Clinical health not elsewhere classified|
|UTAS Author:||Dargaville, PA (Professor Peter Dargaville)|
|UTAS Author:||De Paoli, AG (Dr Tony De Paoli)|
|Web of Science® Times Cited:||128|
|Deposited By:||Menzies Institute for Medical Research|
|Downloads:||5 View Download Statistics|
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