Surfactant administration via thin catheter during spontaneous breathing: randomized controlled trial.
BACKGROUND
The primary aim of this randomized study was to describe the feasibility of early administration of surfactant via a thin catheter during spontaneous breathing (Take Care) and compare early mechanical ventilation (MV) requirement with the InSurE (Intubate, Surfactant, Extubate) procedure.


METHODS
Preterm infants, who were <32 weeks and stabilized with nasal continuous positive airway pressure (nCPAP) in the delivery room, were randomized to receive early surfactant treatment either by the Take Care or InSurE technique. Tracheal instillation of 100 mg/kg poractant α via 5-F catheter during spontaneous breathing under nCPAP was performed in the intervention group. In the InSurE procedure, infants were intubated, received positive pressure ventilation for 30 seconds after surfactant instillation, and placed on nCPAP immediately.


RESULTS
One hundred infants in each group were analyzed. The MV requirement in the first 72 hours of life was significantly lower in the Take Care group when compared with the InSurE group (30% vs 45%, P = .02, odds ratio -0.52, 95% confidence interval -0.94 to -0.29). Mean duration of both nCPAP and MV were significantly shorter in the Take Care group (P values .006 and .002, respectively). Bronchopulmonary dysplasia rate was significantly lower among the infants treated with the Take Care technique (relative risk -0.27, 95% confidence interval -0.1 to -0.72)


CONCLUSIONS
The Take Care technique is feasible for the treatment of respiratory distress syndrome in infants with very low birth weight. It significantly reduces both the need and duration of MV, and thus the bronchopulmonary dysplasia rate in preterm infants.
Zekai Tahir Burak Kadin Sagligi Egitim ve Arastirma Hastanesi, Talatpasa Bulvari, Samanpazari, Ankara; Turkey 06230. gzdekanmaz@yahoo.com
H Gozde
HG
Kanmaz
Omer
O
Erdeve
F Emre
FE
Canpolat
Banu
B
Mutlu
Ugur
U
Dilmen
D001688:Biological Products / Q000008:administration & dosage*; D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control; D002406:Catheterization, Peripheral / Q000295:instrumentation*; D045422:Continuous Positive Airway Pressure; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007322:Instillation, Drug; D008297:Male; D010743:Phospholipids / Q000008:administration & dosage*; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012119:Respiration / Q000187:drug effects*; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy*; D014421:Turkey
D001688:Biological Products; D010743:Phospholipids; D011663:Pulmonary Surfactants; C068291:poractant alfa