Effect of surfactant therapy using an orogastric tube for tracheal catheterization in preterm newborns with respiratory distress

Dr Rps Tomar,Dr R Ghuliani,Dr D Yadav

doi:10.17511/ijpr.2016.i10.04

Abstract

Introduction: Respiratory distress syndrome (RDS) due to surfactant deficiency requires surfactant therapy for which InSurE method (Intubate, Surfactant, Extubate) has been widely used. However this method requires intubation and positive pressure ventilation, even for a short time which is enough to initiate significant lung injury. Recently, surfactant administration by Minimally Invasive Surfactant Therapy (MIST) using a fine catheter under direct laryngoscopy in spontaneously breathing preterms while on nCPAP has reported good outcomes. We prospectively assessed the outcome of a modified MIST method of surfactant administration using an orogastric tube in preterms with RDS. Materials & Methods: A single centre, prospective observational study was conducted where all consecutive eligible inborn preterm neonates with gestation age more than 24 weeks but less than 34 weeks and suffering from RDS were enrolled to receive surfactant using MIST. Results were compared with a historical cohort of preterm who received surfactant with INSURE techniques. Results: Sixty four cases in the modified MIST group were compared with a historic cohort of 68 cases in INSURE group. There were no differences in the requirement of intubation and mechanical ventilation in the first 72 hours but the duration of MV and CPAP were significantly less in modified MIST group. Other neonatal morbidities and mortality rates were similar in either of the groups. Conclusion: The modified MIST technique is an effective method for the treatment of RDS in preterms with better clinical efficacy and comparable outcomes than the more invasive INSURE procedure and deserves further evaluation.

Highlights

Respiratory distress syndrome (RDS) due to surfactant deficiency requires surfactant therapy for which InSurE method (Intubate, Surfactant, Extubate) has been widely used
After a meta-analysis of trials indicated that early nCPAP combined with beneficial effects of surfactant significantly reduced the need for ventilation and subsequent bronchopulmonary dysplasia (BPD), a combination of these methods called as Intubate, Surfactant, Extubate (InSurE) method was propagated which has since been widely used [4]
The results from our study suggest that this modified technique for administering surfactant using orogastric tube and without endotracheal intubation and positive pressure ventilation is well tolerated by preterms on CPAP for treatment of RDS

Summary

Introduction

Respiratory distress syndrome (RDS) due to surfactant deficiency requires surfactant therapy for which InSurE method (Intubate, Surfactant, Extubate) has been widely used. During the last three decades there were significant advances in neonatology to improve the overall survival of the preterms neonates Among these interventions, the significant ones have been antenatal steroids, surfactant therapy and gentler modes of ventilation since the commonest and earliest cause of mortality and morbidity in preterms has been respiratory distress syndrome (RDS) due to surfactant deficiency [1, 2]. After a meta-analysis of trials indicated that early nCPAP combined with beneficial effects of surfactant significantly reduced the need for ventilation and subsequent BPD, a combination of these methods called as Intubate, Surfactant, Extubate (InSurE) method was propagated which has since been widely used [4] This method requires intubation for surfactant administration and positive pressure ventilation, even for a short time which is enough to initiate significant lung injury as it was observed that even these few large artificial breaths increased the risk of BPD [5].

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