Abstract
There is a growing body of evidence over the last years suggesting continuous positive airway pressure (CPAP) ventilation being the first choice of ventilatory support in newborns with extremely low gestational age, and early rescue surfactant treatment being as effective as prophylactic therapy. The Intubation Surfactant Extubation procedure is discussed as an alternative procedure that may have the potential to combine the positive effects of surfactant and early CPAP. A further mode of surfactant administration, administration via a thin endotracheal catheter during spontaneous breathing with CPAP, has recently come into clinical use. This less invasive surfactant administration technique shows some short-term benefits but still cannot be recommended for general use in this vulnerable population. Long-term follow-up studies are needed to allow new recommendations on surfactant therapy in this high-risk population.
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References
Halliday HL. Natural vs. synthetic surfactants in neonatal respiratory distress syndrome. Drugs. 1996;51:226–37.
Ainsworth SB, Beresford MW, Milligan DWA, Shaw NJ, Fenton AC, Ward P. Pumactant and poractant alfa for treatment of respiratory distress syndrome in neonates born at 25–29 weeks’ gestation: A randomised trial. Lancet. 2000;355:1387–92.
Soll RF, Blanco F. Natural surfactant extract versus synthetic surfactant for neonatal respiratory distress syndrome. Cochrane Database Syst Rev. 2001:CD000144.
Soll RF, Morley CJ. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2001:CD000510.
Kendig JW, Ryan RM, Sinkin RA, Maniscalco WM, Notter RH, Guillet C, et al. Comparison of two strategies for surfactant prophylaxis in very premature infants: a multicenter randomized trial. Pediatrics. 1998;101:1006–12.
Gortner L, Wauer RR, Hammer H, Stock GJ, Heitmann F, Reiter HL, et al. Early versus late surfactant treatment in preterm infants of 27 to 32 weeks’ gestational age: A multicenter controlled clinical trial. Pediatrics. 1998;102:1153–60.
Bahadue FL, Soll R. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev. 2012:CD001456.
Morley CJ, David PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB; COIN Trial Investigators. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med. 2008;358:700–8.
SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network, Finer NN, Carlo WA, Walsh MC, Rich W, Gantz MG, Laptook AR, et al. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med. 2010;362:1970–9.
Stevens TP, Finer NN, Carlo WA, Szilagyi PG, Phelps DL, Walsh MC, et al., SUPPORT Study Group of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Respiratory outcomes of the surfactant positive pressure and oximetry randomized trial (SUPPORT). J Pediatr. 2014;165:240–9.
Dunn MS, Kaempf J, de Klerk A, de Klerk R, Reilly M, Howard D, et al. Vermont Oxford Network DRM Study Group. Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates. Pediatrics. 2011;128:e1069–76.
Sandri F, Plavka R, Ancora G, Simeoni U, Stranak Z, Martinelli S, et al. CURPAP Study Group. Prophylactic or early selective surfactant combined with nCPAP in very preterm infants. Pediatrics. 2010;125:e1402–9.
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. Danish-Swedish Multicenter Study Group. N Engl J Med. 1994;331:1051–5.
Kribs A, Pillekamp F, Hünseler C, Vierzig A, Roth B. Early administration of surfactant in spontaneous breathing with nCPAP: Feasibility and outcome in extremely premature infants (postmenstrual age d”27 weeks). Paediatr Anaesth. 2007;17:364–9.
Kribs A, Vierzig A, Hünseler C, Eifinger F, Welzing L, Stützer H, et al. Early surfactant in spontaneously breathing with nCPAP in ELBW infants–a single centre four year experience. Acta Paediatr. 2008;97:293–8.
Kribs A, Härtel C, Kattner E, Vochem M, Küster H, Möller J, et al. Surfactant without intubation in preterm infants with respiratory distress: First multi-center data. Klin Padiatr. 2010;222:13–7.
Göpel W, Kribs A, Ziegler A, Laux R, Hoehn T, Wieg C, et al. German Neonatal Network. Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. Lancet. 2011;378:1627–34.
Kribs A. How best to administer surfactant to VLBW infants? Arch Dis Child Fetal Neonatal Ed. 2011;96:F238–40.
Dargaville PA, Aiyappan A, Cornelius A, Williams C, De Paoli AG. Preliminary evaluation of a new technique of minimally invasive surfactant therapy. Arch Dis Child Fetal Neonatal Ed. 2011;96:F243–8.
Dargaville PA, Kamlin CO, De Paoli AG, Carlin JB, Orsini F, Soll RF, et al. The OPTIMIST-A trial: evaluation of minimally-invasive surfactant therapy in preterm infants 25–28 weeks gestation. BMC Pediatr. 2014;14:213.
Klebermass-Schrehof K, Wald M, Schwindt J, Grill A, Prusa AR, Haiden N, et al. Less invasive surfactant administration in extremely preterm infants: impact on mortality and morbidity. Neonatology. 2013;103:252–8.
Aguar M, Cernada M, Brugada M, Gimeno A, Gutierrez A, Vento M. Minimally invasive surfactant therapy with a gastric tube is as effective as the intubation, surfactant, and extubation technique in preterm babies. Acta Paediatr. 2014;103:e229–33.
More K, Sakhuja P, Shah PS. Minimally invasive surfactant administration in preterm infants: A metanarrative review. JAMA Pediatr. 2014;168:901–8.
Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European Association of Perinatal Medicine. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants — 2010 update. Neonatology. 2010;97:402–17.
Polin RA, Carlo WA; Committee on Fetus and Newborn; American Academy of Pediatrics. Surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics. 2014;133:156–63.
Committee on Fetus and Newborn; American Academy of Pediatrics. Respiratory support in preterm infants at birth. Pediatrics. 2014;133:171–4.
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Eibisberger, M., Resch, E. & Resch, B. Surfactant replacement therapy in extremely low gestational age newborns. Indian Pediatr 52, 227–230 (2015). https://doi.org/10.1007/s13312-015-0612-3
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DOI: https://doi.org/10.1007/s13312-015-0612-3