Minimally Invasive Surfactant Administration for the Treatment of Neonatal Respiratory Distress Syndrome: A Multicenter Randomized Study in China.

Rui Jiang,Qi Gao,Ming Guo,Ling Li,Weili Liu,Tao Han ,Xinjian Liu,Lisha Bao,Mingtao Zhang,Xiaomei Tong,Jun Zheng,Xuefeng Zhang,Min Xiao,Wanxian Zhang,Yang Duan,Wei Guo,Huiqiang Liu,Xiang Zhang,Hui Zhang,Fengze Sun ,Xiuying Tian,Fang Liu

doi:10.3389/fped.2020.00182

Abstract

Background/Aims: Nasal continuous positive airway pressure (nCPAP) was recommended as the initial respiratory support for spontaneous breathing in infants with very low birth weight and neonatal respiratory distress syndrome (NRDS). Less invasive surfactant administration (LISA) and minimally invasive surfactant therapy (MIST) have been reported to reduce the incidence of bronchopulmonary dysplasia (BPD). This study aimed to explore the applicability of minimally invasive surfactant administration (MISA) in China.Materials and Methods: MISA was a randomized controlled study conducted at eight level III neonatal intensive care units (NICUs) in China. Spontaneously breathing infants born at 25+0 to 31+6 weeks' gestation who progressively developed respiratory distress during the first 6 h after birth were randomly assigned to receive MISA or endotracheal intubation surfactant administration (EISA). The primary outcome was the difference in the morbidity of BPD between two groups of infants with MISA and EISA at 36 weeks corrected gestational age.Results: Demographic and clinical characteristics of the 151 infants in the MISA group were similar to the 147 infants in the EISA group. The comparison showed no clear benefits in the MISA group in the incidence of BPD, while infants from the EISA group had higher rates of patent ductus arteriosus (PDA) (60.5 vs. 41.1%, p = 0.001). The duration of surfactant infusion and the total time of surfactant administration in the MISA group were significantly longer than in the EISA group. A slightly increased heart rate was noted 1 h post surfactant administration in the EISA group. In subgroup analysis, the comparison of 51 smaller (<30 weeks) preterm infants, named MISAs (n = 31) and EISAs (n = 20), showed a significant reduction of BPD (29.0 vs. 70.0%, p = 0.004) and PDA (29.0 vs. 65.0%, p = 0.011). In the subgroup analysis of blood gas, arterial oxygen saturation (SaO2) value at 1 and 12 h and partial pressure of arterial oxygen (PaO2) at 12 h were all higher in the EISA group compared to the MISA group.Conclusion: MISA had no clear benefit on the incidence of BPD, but it was related to a reduction in PDA. It is an appropriate therapy for spontaneous breathing in infants with extremely low birth weight and NRDS.

Highlights

Pulmonary surfactant is key to normal alveolar expansion
We evaluated whether minimally invasive surfactant administration (MISA) was applicable in infants at 25 weeks to 31 + 6 weeks gestational age in China, and whether this method of surfactant administration decreases incidence of BPD at 36 weeks corrected gestational age compared with intubation surfactant administration therapy
The results suggested that the lower group was related to a higher risk of death and necrotizing enterocolitis (NEC), and a lower risk of retinopathy of prematurity (ROP) and BPD

Summary

Introduction

Pulmonary surfactant is key to normal alveolar expansion. It is secreted by the type II pneumocytes to decrease surface tension, leading to increased compliance and decreased atelectasis [1]. Neonatal respiratory distress syndrome (NRDS) is a disorder of surfactant deficiency, especially preterm infants

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