title: Nebulization of Poractant alfa via a vibrating membrane nebulizer in spontaneously breathing preterm lambs with binasal continuous positive pressure ventilation.
abstract: BACKGROUND
  Surfactant replacement therapy is the gold standard treatment of neonatal respiratory distress (RDS). Nebulization is a noninvasive mode of surfactant administration. We administered Poractant alfa (Curosurf) via a vibrating perforated membrane nebulizer (eFlow Neonatal Nebulizer) to spontaneously breathing preterm lambs during binasal continuous positive pressure ventilation (CPAP).
  
  
  METHODS
  Sixteen preterm lambs were operatively delivered at a gestational age of 133 ± 1 d (term ~150 d), and connected to CPAP applied via customized nasal prongs. Nebulization was performed (i) with saline or (ii) with surfactant for 3 h in humidified or (iii) nonhumidified air, and with surfactant (iv) for 60 min or (v) for 30 min. We measured arterial oxygenation, lung gas volumes and surfactant pool size and deposition.
  
  
  RESULTS
  Nebulization of surfactant in humidified air for 3 h improved oxygenation and lung function, and surfactant was preferentially distributed to the lower lung lobes. Shorter nebulization times and 3 h nebulization in dry air did not show these effects. Nebulized surfactant reached all lung lobes, however the increase of surfactant pool size missed statistical significance.
  
  
  CONCLUSIONS
  Positive effects of surfactant nebulization to spontaneously breathing preterm lambs depend on treatment duration, surfactant dose, air humidity, and surfactant distribution within the lung.
authors: Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands.|Neonatology, Department of Pediatric and Adolescent Medicine, University Hospital, Medical Faculty RWTH, Aachen, Germany.
authors: Matthias C
authors: MC
authors: Hütten
authors: Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands.
authors: Elke
authors: E
authors: Kuypers
authors: Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands.
authors: Daan R
authors: DR
authors: Ophelders
authors: Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands.
authors: Maria
authors: M
authors: Nikiforou
authors: Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands.
authors: Reint K
authors: RK
authors: Jellema
authors: Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands.
authors: Hendrik J
authors: HJ
authors: Niemarkt
authors: Research and Development Department, Pari Pharma GmbH, Munich, Germany.
authors: Carola
authors: C
authors: Fuchs
authors: Research and Development Department, Pari Pharma GmbH, Munich, Germany.
authors: Markus
authors: M
authors: Tservistas
authors: Research and Development Department, Chiesi Farmaceutici SpA, Parma, Italy.
authors: Roberta
authors: R
authors: Razetti
authors: Research and Development Department, Chiesi Farmaceutici SpA, Parma, Italy.
authors: Federico
authors: F
authors: Bianco
authors: Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands.
authors: Boris W
authors: BW
authors: Kramer
mesh_terms: D000280:Administration, Inhalation; D000818:Animals; D000831:Animals, Newborn; D001688:Biological Products / Q000008:administration & dosage*; D045422:Continuous Positive Airway Pressure; D004195:Disease Models, Animal; D004867:Equipment Design; D005865:Gestational Age; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008567:Membranes, Artificial; D009330:Nebulizers and Vaporizers; D010743:Phospholipids / Q000008:administration & dosage*; D047928:Premature Birth; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012119:Respiration / Q000187:drug effects*; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology / Q000628:therapy*; D012756:Sheep; D013997:Time Factors; D014732:Vibration
chemical_list: D001688:Biological Products; D008567:Membranes, Artificial; D010743:Phospholipids; D011663:Pulmonary Surfactants; C068291:poractant alfa