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Minimally-invasive surfactant therapy in preterm infants on continuous positive airway pressure

Citation

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 Statement

Copyright 2013 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health

DOI: doi:10.1136/archdischild-2011-301314

Abstract

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 (2528 weeks gestation, n=38) or ≥0.35 (2932 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 2528 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 2932 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 Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Paediatrics and Reproductive Medicine
Research Field:Paediatrics
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Respiratory System and Diseases (incl. Asthma)
Author:Dargaville, PA (Professor Peter Dargaville)
Author:De Paoli, AG (Dr Tony De Paoli)
ID Code:87961
Year Published:2013
Web of Science® Times Cited:60
Deposited By:Menzies Institute for Medical Research
Deposited On:2013-12-19
Last Modified:2014-07-21
Downloads:5 View Download Statistics

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