Skip to main content
Download PDF

Early rescue administration of surfactant and nasal continuous positive airway pressure in preterm infants <32 weeks gestation

Indian Pediatrics volume 48, Article number: 601 (2011) Cite this article

Abstract

Objective

This study reports our institutional experience on the outcome after prophylactic and early rescue endotracheal instillation of surfactant within 20 minutes of birth, followed by extubation and nasal continuous positive airway pressure (NCPAP) in preterm infants <32 weeks gestational age.

Patients and methods

A total of 142 infants were prospectively studied (42, gestational age from 23 to 27 and 100, from 28 up to 32 weeks). All infants were electively intubated for administration of 200mg/kg porcine isolated surfactant (Curosurf, Chiesi Farmaceutici SPA, Parma, Italy) as soon as practicably possible (within 20 min after birth) and NCPAP was then initiated.

Results

Extubation and switch to NCPAP at 6h was successful in 6/42 (14.3%) infants less than 28 weeks gestational age and 75/100 (75%) infants 28–32 weeks gestational age. Out of 81 infants that were successfully extubated, 76 (93.83%) never required re-ventilation. At 96h of age, need for continuing intubation and ventilation was required by 6/38 (15.8%) alive infants <28 weeks gestational age and 8/100 (8%) infants 28–32 weeks gestational age. Mean duration of NCPAP post-extubation was 38±20 hours for infants 23–27 wks and 29±15 hours for infants 28–32 wks gestational age. The mortality rate was 2.81% (4/142).

Conclusion

Implementation of prophylactic or early rescue administration of surfactant with NCPAP in infants at high risk for developing RDS in neonatal ICU is a safe modality of respiratory support in preterm infants.

References

  1. Fujiwara T, Konishi M, Chida S, Okuyama K, Ogawa Y, Takeuchi Y, et al. The Surfactant-TA Study Group. Surfactant replacement therapy with a single post ventilatory dose of a reconstituted bovine surfactant in preterm neonates with respiratory distress syndrome: final analysis of a multicenter, double blind randomized trial and comparison with similar trials. Pediatrics. 1990;86:753–764.

    PubMed  CAS  Google Scholar 

  2. Walti H, Paris-Lado J, Egberts J, Brand R, Bevilacqua G, Gardini F, et al. Prophylactic administration of porcinederived lung surfactant is a significant factor in reducing the odds for peri-intraventricular haemorrhage in premature infants. Biol Neonate. 2002;81:182–187.

    PubMed  Article  CAS  Google Scholar 

  3. Gortner L, Wauer RR, Hammer H, Stock GJ, Heitmann F, Reiter HL, et al. Early versus late surfactant treatment in preterm infants of 27–32 weeks’ gestational age: a multicenter controlled clinical trial. Pediatrics 1998;102: 1153–1169.

    PubMed  Article  CAS  Google Scholar 

  4. Yost CC, Soll RF. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database System Rev. 2000;2:CD001456.

    Google Scholar 

  5. Soll RF, Morley CJ. Prophylactic versus selective use of surfactant for preventing morbidity and mortality in preterm infants. Cochrane Database System Rev. 2002;1: CD000510.

    Google Scholar 

  6. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33:179–201.

    PubMed  CAS  Google Scholar 

  7. An international classification of retinopathy of prematurity. Prepared by an International Committee. Br J Opthalmol. 1984;68:690–697.

    Google Scholar 

  8. Dani C, Bertini G, Pezzati M, Cecchi A, Caviglioli C, Rubalteli FF. Early extubation and nasal continuous positive airway pressure after surfactant treatment in preterm infants of less than 30 weeks’s gestation. Pediatrics. 2004;113:560–563.

    Article  Google Scholar 

  9. Haberman B, Shankaran S, Stevenson DK, Papile LA, Stark A, Korones S, et al. Does surfactant and immediate extubation to nasal continuous positive airway pressure reduce use of mechanical ventilation? Pediatric Res. 2002;51:349A.

    Google Scholar 

  10. Reininger A, Khalak R, Kendig JW, Ryan RM, Stevens TP, Reubens L, et al. Surfactant administration by transient intubation in infants 29–35 weeks’ gestation with respiratory distress syndrome decreases need of later mechanical ventilation: a randomised controlled trial. J Perinatol. 2005;25:703–708.

    PubMed  Article  CAS  Google Scholar 

  11. The Texas Neonatal Research Group 2004. Early surfactant for neonates with mild to moderate respiratory distress syndrome: A multicenter randomised trial. J Pediatr. 2004;144:804–808.

    Google Scholar 

  12. Tooley J, Dyke M. Randomized study of nasal continuous positive airway pressure in the preterm infant with respiratory distress syndrome. Acta Paediatr. 2003;92: 1170–1174.

    PubMed  Article  CAS  Google Scholar 

  13. Merritt TA, Cochrane CG, Holcomb K, Bohl B, Hallman M, Strayer D, et al. Elastase and alpha 1 proteinase inhibitor aspirates during RDS. Role of inflammation in the pathogenesis of BPD. J Clin Invest. 1983;72:656–666.

    PubMed  Article  CAS  Google Scholar 

  14. Payne N, LaCorte M, Karna P, Chen S, Finkelstein M, Goldsmith J, et al. Reduction of bronchopulmonary dysplasia after participation in the Breathsavers Group of the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative. Pediatrics. 2006;118Suppl 2: S73–S77.

    PubMed  Article  Google Scholar 

  15. Flynn JT, Bancalari E, Snyder ES, Goldberg RN, Feuer W, Cassady J, et al. A cohort study of transcutaneous oxygen tension and the incidence and severity of retinopathy of prematurity. N Engl J Med. 1992;326:1050–1054.

    PubMed  Article  CAS  Google Scholar 

  16. Verder H, Robertson B, Greisen G, Ebbesen F, Albertsen P, Lundstrøm K, et al. Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. N Engl J Med. 1994;331: 1051–1055.

    PubMed  Article  CAS  Google Scholar 

  17. Stevens TP, Blennow M, Myers EH, Soll R. Early surfactant administration with brief ventilation vs selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cohrane Database Syst Rev. 2007;4: CD003063.

    Google Scholar 

Download references

Author information

Affiliations

  1. Second NICU and Neonatology Department, Aristotle University of Thessaloniki, GPN Papageorgiou, Ring Road Nea Efkarpia, 56403, Thessaloniki, Greece

    Christos Tsakalidis, Maria Kourti, Paraskevi Karagianni, Dimitris Rallis, Maria Porpodi & Nikolaos Nikolaidis

Authors
  1. Christos Tsakalidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Kourti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paraskevi Karagianni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dimitris Rallis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maria Porpodi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nikolaos Nikolaidis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christos Tsakalidis.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Tsakalidis, C., Kourti, M., Karagianni, P. et al. Early rescue administration of surfactant and nasal continuous positive airway pressure in preterm infants <32 weeks gestation. Indian Pediatr 48, 601 (2011). https://doi.org/10.1007/s13312-011-0104-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s13312-011-0104-z

Key words

  • Greece
  • Management
  • Nasal continuous positive airway pressure
  • Outcome
  • Prematurity
  • Respiratory distress syndrome
  • Surfactant