title: Surfactant administration without intubation in preterm infants with respiratory distress syndrome--our experiences.
abstract: BACKGROUND
  Surfactant replacement therapy is crucial in the management of respiratory distress syndrome (RDS) in preterm infants. Classic strategies of surfactant administration required intubation. To reduce the need of intubation and mechanical ventilation (MV), we applied surfactant via a thin endotracheal catheter without intubation.
  
  
  METHODS
  We compared 26 preterm infants threatened by RDS treated with surfactant via a thin endotracheal catheter without intubation (studied group - SG) with a retrospective group of preterm infants managed on MV with early surfactant treatment using INtubation SURfactant Extubation (INSURE) method (control group - CG). Study had an approval from the ethics committee (RNN/6/14/KE).
  
  
  RESULTS
  In the SG, 26 preterm infants were treated with one dose of surfactant (Curosurf®) administered via endotracheal catheter without intubation while receiving nasal continuous positive airway pressure (nCPAP)/SiPAP (Infant Flow). After surfactant administration, significantly less patients in SG required intubation and MV (19.2%) versus 65% necessity of second intubation in the CG. The median of time of MV in SG was 5 d versus 3.5 d in CG. Median time spent on nCPAP was 5.5 d versus 4.0 d in CG. The incidence of intraventricular hemorrhage (IVH) in the SG was 53.9%, including 50% with ≥ IVH II versus 36.7% (30% ≥ IVH II) in CG. The incidence of other complications of prematurity in the SG, such as necrotizing enterocolitis was 11.5% versus 23.3% in CG, the hemodynamically important patent ductus arteriosus was observed in 53.9% in SG versus 45% in CG. Bronchopulmonary dysplasia level in SG was significantly lower (15.4%) than in CG (40%), and the incidence of retinopathy of prematurity in SG was also lower (3.9%) versus 11.7% in MV group.
  
  
  CONCLUSIONS
  Surfactant application via a thin endotracheal catheter without intubation seems to be a beneficial therapy for preterm infants with slight and mild degree of RDS. This new method of surfactant application was associated with a lower prevalence of intubation and MV and better pulmonary outcome than implementation of traditional surfactant therapy (INSURE) and MV. Prospective randomized controlled trial is required.
authors: a Department of Neonatology , Pirogow's Hospital , Lodz , Poland and.
authors: Paweł
authors: P
authors: Krajewski
authors: Anita
authors: A
authors: Chudzik
authors: Barbara
authors: B
authors: Strzałko-Głoskowska
authors: Monika
authors: M
authors: Górska
authors: Magdalena
authors: M
authors: Kmiecik
authors: Katarzyna
authors: K
authors: Więckowska
authors: Anna
authors: A
authors: Mesjasz
authors: Piotr
authors: P
authors: Sieroszewski
mesh_terms: D060666:Airway Extubation / Q000009:adverse effects / Q000379:methods*; D002404:Catheterization / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007442:Intubation, Intratracheal; D008297:Male; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D011663:Pulmonary Surfactants
keywords: Preterm newborn; respiratory distress syndrome; surfactant without intubation