Preliminary evaluation of a new technique of minimally invasive surfactant therapy.
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.


METHODS
Non-randomised feasibility study.


METHODS
Tertiary neonatal intensive care unit.


METHODS
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 O(2) concentration (FiO(2)), and enrolment of 29-34-week infants (n=14) at CPAP pressure ≥7 cm H(2)O and FiO(2) ≥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.


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 FiO(2) 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.
Dargaville
Peter A
PA
Department of Paediatrics, Royal Hobart Hospital and University of Tasmania, Hobart, Australia. peter.dargaville@dhhs.tas.gov.au
Aiyappan
Ajit
A
Cornelius
Anita
A
Williams
Christopher
C
De Paoli
Antonio G
AG
D001724:Birth Weight; D002406:Catheterization, Peripheral / Q000295:instrumentation / Q000379:methods; D003131:Combined Modality Therapy; D045422:Continuous Positive Airway Pressure / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011663:Pulmonary Surfactants / Q000008:administration & dosage* / Q000627:therapeutic use; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D016896:Treatment Outcome
D011663:Pulmonary Surfactants