Exogenous Surfactant Administration Research Articles

STABLE MICROBUBBLE TEST IN THE EARLY DIAGNOSIS OF NEWBORN RESPIRATORY DISTRESS SYNDROME

Objective: To analyze the importance of SMT in the early diagnosis of NRDS in newborns (NB) with gestational age between 32 and 37 weeks with respiratory distress. Methodology: observational, cohort study. Data collection occurred in a public hospital in southern Brazil between March 2018 and February 2020. Results: The groups of patients with and without respiratory distress were compared in relation to the number of stable microbubbles. Among the NBs with respiratory distress (RD), 50% presented between 15 and 50 SM/mm² and 50% above 50 SM/mm². On the other hand, 18% of the patients without RD presented between 15 and 50 SM/mm², while 82% presented more than 50 SM/mm², with no significant difference or association. The mothers of NBs with RD received pre-delivery corticosteroid therapy, a protective factor for developing NRDS, not requiring the administration of exogenous surfactant. Conclusion: using the SMT to aid in the diagnosis of NRDS was an effective method since there was no NB with less than 15 SM/mm² and no NB required exogenous surfactant. Certainly, the amount greater than 15 SM/mm² in NB with respiratory distress accuses moderate or severe SDRRN, which does not require administrating exogenous surfactant.

Non-invasive versus invasive respiratory support in preterm infants

Respiratory insufficiency is almost ubiquitous in infants born preterm, with its incidence increasing with lower gestational age. A wide range of respiratory support management strategies are available for these infants, separable into non-invasive and invasive forms of respiratory support. Here we review the history and evolution of respiratory care for the preterm infant and then examine evidence that has emerged to support a non-invasive approach to respiratory management where able. Continuous positive airway pressure (CPAP) is the non-invasive respiratory support mode currently with the most evidence for benefit. CPAP can be delivered safely and effectively and can commence in the delivery room. Particularly in early life, time spent on non-invasive respiratory support, avoiding intubation and mechanical ventilation, affords benefit for the preterm infant by virtue of a lessening of lung injury and hence a reduction in incidence of bronchopulmonary dysplasia. In recent years, enthusiasm for application of non-invasive support has been further bolstered by new techniques for administration of exogenous surfactant. Methods of less invasive surfactant delivery, in particular with a thin catheter, have allowed neonatologists to administer surfactant without resort to endotracheal intubation. The benefits of this approach appear to be sustained, even in those infants subsequently requiring mechanical ventilation. This cements the notion that any reduction in exposure to mechanical ventilation leads to alleviation of injury to the vulnerable preterm lung, with a long-lasting effect. Despite the clear advantages of non-invasive respiratory support, there will continue to be a role for intubation and mechanical ventilation in some preterm infants, particularly for those born <25 weeks’ gestation. It is currently unclear what role early non-invasive support has in this special population, with more studies required.

Risk factors of preterm infants with CPAP intubated for mechanical ventilation

Early use of continuous positive airway pressure (CPAP) is equal to the prophylactic administration of a surfactant to prevent neonatal respiratory distress syndrome (nRDS) in high-risk infants. However, almost half of the smallest infants still require intubation and mechanical ventilation in the first 72 hours after birth. It is known that ineffective initial CPAP is associated with a poorer prognosis. Therefore, the search for reliable prognostic risk factors for ineffective CPAP in very preterm neonates whose respiratory support is started with CPAP is still relevant today. The results of a retrospective cohort study conducted at the Lviv Regional Clinical Hospital (Ukraine), which included 151 children with birth weight &lt;1500 g and gestational age &lt;32 weeks, showed that CPAP failure occurred at a median age of five hours in 31% of infants initially treated with CPAP and average (SD) FiO2, while the failure point was 0.48 (0.15). The prevalence of the main risk factors for severe nRDS did not differ significantly between two groups (CPAP success and CPAP failure). The risk of CPAP failure was significantly associated with surfactant treatment (OR – 7.46; 95% CI: 2.3–24.2), severe RDS (OR – 12.17; 95% CI: 3.8–39.3), requirement in resuscitation after birth (OR – 3.10; 95% CI: 1.2–8.1), initial CPAP pressure (OR – 0.38; 95% CI: 0.15–0.99). Earlier administration of exogenous surfactant to children at high risk of developing severe RDS could prevent the need for mechanical ventilation. Keywords: CPAP failure, neonatal respiratory distress syndrome mechanical ventilation, preterm infants, surfactant

Endobronchial surfactant administration in full-term newborn with respiratory distress syndrome

Neonatal respiratory distress syndrome is the leading cause of neonatal acute respiratory failure. Despite the successes achieved and the existing international recommendations, in some cases there is a severe course of this disease, which requires a personalized approach to the patient and intensive care measures.&#x0D; The article presents a case of successful treatment of acute respiratory distress syndrome in a full-term newborn complicated by pulmonary barotrauma using monobronchial administration of exogenous surfactant under X-ray control. In order to assess the course of the disease and the effectiveness of treatment, a retrospective analysis of medical documentation was carried out. From the first minutes of life, the child had respiratory disorders, which was the basis for non-invasive mechanical lung ventilation nCPAP (nasal continuous positive airway pressure). Progression of hypercapnia and hypoxemia was revealed over time, and therefore tracheal intubation was performed and convective mechanical ventilation was started with FiO2 = 1,0. Monobronchial administration of exogenous surfactant was a key element of the therapy that allowed to achieve stabilization of the condition and regression of gas exchange disorders with complete recovery of the patient.&#x0D; Monobronchial administration of surfactant in acute respiratory distress syndrome with heterogeneous lung involvement is an effective treatment option and can be used in clinical practice for refractory hypoxemia.

Early Surfactant Therapy for Respiratory Distress Syndrome in Very Preterm Infants.

It is currently considered that early initiation of nasal continuous positive airway pressure, using a less invasive exogenous surfactant administration and avoiding mechanical ventilation as much as possible to minimize lung damage, may reduce mortality and/or the risk of morbidities in preterm infants. The aim of our study was to quantify our experience and compare different strategies of surfactant administration, to investigate which method is associated with less morbidity. A total of 135 preterm infants with early rescue surfactant administration for respiratory distress syndrome were included in the study. The infants were treated in an academic, Level III Neonatal Intensive Care Unit over a 3-year period between 1 December 2018 and 1 December 2021. Patients were separated into three groups: those with standard surfactant administration; those with Less Invasive Surfactant Administration-LISA; and those with Intubation Surfactant Administration Extubation-INSURE. As a primary outcome, we followed the need for intubation and mechanical ventilation within 72 h, while the secondary outcomes were major neonatal morbidities and death before discharge. The surfactant administration method was significantly associated with the need for mechanical ventilation within 72 h after the procedure (p < 0.001). LISA group infants needed less MV (OR = 0.538, p = 0.019) than INSURE group infants. We found less morbidities (OR = 0.492, p = 0.015) and deaths before discharge (OR = 0.640, p = 0.035) in the LISA group compared with the INSURE group. The analysis of morbidities found in infants who were given the surfactant by the LISA method compared with the INSURE method showed lower incidence of pneumothorax (3.9% vs. 8.8%), intraventricular hemorrhage (17.3% vs. 23.5%), intraventricular hemorrhage grade 3 and 4 (3.9% vs. 5.9%), sepsis/probable sepsis (11.5% vs. 17.7%) retinopathy of prematurity (16.7% vs. 26.7%) and deaths (3.9% vs. 5.9%). There were no significant differences between groups in frequencies of bronchopulmonary dysplasia, necrotizing enterocolitis and patent ductus arteriosus. Less invasive surfactant administration methods seem to have advantages regarding early need for mechanical ventilation, decreasing morbidities and death rate. In our opinion, the LISA procedure may be a good choice in spontaneously breathing infants regardless of gestational age.

Lung ultrasound to guide the administration of exogenous pulmonary surfactant in respiratory distress syndrome of newborn infants: A retrospective investigation study.

Respiratory distress syndrome (RDS) is a common disease that seriously endangers the life and safety of newborns, especially premature infants. Exogenous pulmonary surfactant (PS) is the specific agent for the treatment of neonatal RDS. Lung ultrasound (LUS) has been successfully used in the diagnosis of RDS, but its value in guiding the application of PS is still unclear. This paper explored whether the application of PS under LUS monitoring has some advantages, including (1) decreasing the misdiagnosis rate of RDS and decreasing probability of using PS, and (2) reducing the dose of PS without reducing the therapeutic effect. This study included two parts. Part 1: To decide whether the LUS is good to differentiate RDS from other lung diseases in the premature infants. All patients who were diagnosed with RDS and required PS treatment based on conventional criteria were routinely examined by LUS. Then, according to LUS findings, we decided whether they needed to receive PS treatment. Part 2: To see the dose reduction of surfactant is applicable. In RDS patients diagnosed based on LUS presentation and treated with Curosurf (Chiesi Pharmaceutical, Parma, Italy), the dose of Curosurf was compared with that recommended by the European RDS management guidelines. (1) Since March 2017, 385 newborn infants admitted to our neonatal intensive care unit met the traditional diagnostic criteria of RDS. Of these, only 269 cases were diagnosed with RDS and needed PS treatment according to LUS manifestations. The other 116 infants who did not meet the criteria for ultrasound diagnosis of RDS did not receive PS supplementation but obtained good outcomes, that is LUS findings decreased a misdiagnosis rate of RDS by 30.1% and subsequently resulted in a 30.1% reduction in PS use. (2) Among the 269 RDS patients diagnosed based on LUS findings, 148 were treated with Curosurf (another 121 RDS infants who received domestic PS treatment were not included in the study group), and the average dose was 105.4 ± 24.3 mg/kg per time, which is significantly lower than the dose of 200 mg/kg per time recommended by the European RDS guidelines. (3) The mortality rate of RDS patients was 0%, and no patients had ventilator-associated pneumonia or bronchopulmonary dysplasia in this study. LUS can decrease the misdiagnosis rate of RDS, thereby decreasing the probability of using PS and decreasing the dose of PS, and can help RDS infants to achieve better outcomes.

Lowering of the Neonatal Lung Ultrasonography Score after nCPAP Positioning in Neonates over 32 Weeks of Gestational Age with Neonatal Respiratory Distress.

Respiratory distress (RD) is one of the most common causes of admission to the neonatal intensive care unit. Correct diagnosis and timely intervention are crucial. Lung ultrasonography (LU) is a useful diagnostic tool for the neonatologist in the diagnosis of RD; the neonatal lung ultrasonography score (nLUS) can be used in the diagnostic process, but some authors hypothesise that it is also useful for the management of some neonatal RD. The aim of this study is to analyse the changes in nLUS score before (T0) and after (T1) the start of respiratory support with nasal CPAP in neonates over 32 weeks of age with RD. Thirty-three newborns were enrolled in this retrospective study. LU was performed before and after the start of CPAP. The median nLUS scores at T0 and T1 were 9 (IQR 7–12) and 7 (IQR 4–10), respectively, and showed a significant difference (p < 0.001). The magnitude of reduction in nLUS score, expressed as a percentage, was inversely related to the need for subsequent administration of exogenous surfactant. The study suggests the usefulness of the nLUS score in assessing the response to CPAP in neonates over 32 weeks gestational age.

Features of respiratory disorders and vitamin D status in preterm infants with a gestational age of more than 32 weeks

Background. Preterm infants are at high risk for respiratory distress and vitamin D deficiency, which may be associated with a need for intensive care and long-term respiratory support.&#x0D; Aim. To study the features of respiratory disorders and vitamin D status in preterm infants with a gestational age of more than 32 weeks.&#x0D; Materials and methods. The object of the study were 64 moderate and late preterm infants with respiratory disorders and their mothers. The level of 25(OH)D in cord blood serum was determined by enzyme immunoassay.&#x0D; Results. 60.9% of children were diagnosed with respiratory distress syndrome (Group 1), 39.1% had congenital pneumonia (Group 2). Mothers of all children had a high incidence of chronic diseases and pregnancy complications. Hypovitaminosis D was detected in 71.888% of newborns of both groups, mainly at the stage of deficiency. The median concentrations of 25(OH)D in cord blood serum were 15.41 [12.4934.25] ng/ml in the 1st group of newborns, and 18.42 [14.0123.44] ng/mL in the 2nd group. The need for exogenous surfactant administration and CPAP respiratory therapy is significantly higher in neonates with respiratory distress syndrome. Children with congenital pneumonia significantly more often required mechanical ventilation, and they also had a longer total duration of respiratory support in the form of humidified oxygen supplementation. The duration of inpatient treatment in children of both groups with hypovitaminosis D was significantly higher compared to newborns with adequate levels of vitamin D.&#x0D; Conclusion. Moderate and late preterm infants with respiratory problems should be identified at high risk for hypovitaminosis D, screened for blood levels of 25(OH)D, and developed optimal vitamin D supplementation regimens a promising direction to reduce the risk of preterm birth, neonatal morbidity and reduce the time of inpatient treatment of respiratory disorders.

The exogenous surfactant pre-treatment attenuates ventilator-induced lung injury in adult rats

Mechanical ventilation is an essential supportive therapy in the treatment of critical patients, and it aims to maintain adequate gas exchange; however, it can also contribute to inflammation and oxidative stress, thus leading to lung injury. We tested the hypothesis that exogenous surfactant administration will be protective against ventilator-induced lung injury in adult healthy Wistar rats both because of its anti-inflammatory properties as well as its role in preventing alveolar collapse at end-expiration. Thus, the effect of intranasal instillation of a bovine exogenous surfactant was tested in Wistar rats submitted to mechanical ventilation. The animals were divided into four groups: (1) CONTROL; (2) SURFACTANT; (3) Mechanical ventilation (MV); (4) MV with pre-treatment with surfactant (MVSURFACTANT). The MV and MVSURFACTANT were submitted to MV with high tidal volume (12 mL/kg) for 1 h. After the experimental protocol, all animals were euthanized and the arterial blood, bronchoalveolar lavage fluid and lungs were collected for biochemical, immunoenzymatic assay, arterial blood gases, and morphometric analyzes. The Wistar rats that received exogenous surfactant (Survanta®) by intranasal instillation before MV demonstrated reduced levels of leukocytes, inflammatory biomarkers such as CCL2, IL-1, IL-6 and TNF-α. Furthermore, it prevented oxidative damage by reducing lipid peroxidation and protein carbonylation as well as histological pattern changes of pulmonary parenchyma. Our data indicate that exogenous surfactant attenuated lung inflammation and redox imbalance induced by mechanical ventilation in healthy adult rats suggesting a preventive effect on ventilator-induced lung injury.

Noninvasive Ventilation and Exogenous Surfactant in Times of Ever Decreasing Gestational Age: How Do We Make the Most of These Tools?

Noninvasive Ventilation and Exogenous Surfactant in Times of Ever Decreasing Gestational Age: How Do We Make the Most of These Tools?

Clinical outcome of preterm babies managed for respiratory distress syndrome using nasal continuous positive airway pressure and surfactant: An experience from Ile-Ife, South-Western Nigeria

Background: Respiratory distress syndrome (RDS) is a common cause of morbidity and mortality among preterm babies. It is caused by a deficiency of surfactant; hence, there is reduced lung compliance and increased work of breathing. The use of continuous positive airway pressure (CPAP) ventilation, a noninvasive form of ventilation, as well as the administration of exogenous surfactant, has proven to be very useful in the management of RDS. The use of less invasive techniques in ventilation and administration of surfactant have also been shown to reduce the risk of bronchopulmonary dysplasia and adverse effect of intubation. Objective: The objective is to determine mean oxygen saturation at 1 h, 6 h, and 12 h after commencement of CPAP, the mean values of FiO2 and positive end-expiratory pressure before and after administration of surfactant, and the overall case-fatality rate and birth weight-specific mortality rates. Methods: Study design was a prospective observational study and subjects were inborn babies between 26 and 34 weeks gestation who were managed for RDS with CPAP alone or with additional surfactant. Results: All 104 recruited preterm babies were managed with CPAP. Fifty-six (53.8%) babies also had surfactant administered. The mean weight of the babies was 1.35 (±0.322) kg, and the mean gestational age was 30.95 (±2.24) weeks. Extremely low birth weight (ELBW), very low birth weight (VLBW), and LBW constituted 11.5%, 55.8%, and 32.7% of the study population, respectively. The mean SPO2 before CPAP and 12 h after were 90.93 (±5.39) % and 96.5 (±3.30) %, respectively. The overall case-fatality rate was 18.2%, and birth-weight-specific mortality rates for ELBW, VLBW, and LBW were 58.3%, 15.5%, and 9.7%, respectively. Conclusion: From this study, it is clear that the prompt use of a cost-effective CPAP devices and the administration of surfactant are very effective in reducing morbidity and mortality among VLBW babies. While most local studies focused on the experience with the use of CPAP alone, this study goes further to demonstrate that the use of CPAP and surfactant is more effective in the management of RDS.

Administration of Exogenous Surfactant and Cytosolic Phospholipase A2α Inhibitors may Help COVID-19 Infected Patients with Chronic Diseases

Background : Coronavirus-19 (COVID-19) pandemic is a worldwide public health problem causing 347,070 deaths from December 25, 2019, till May 25, 2020. Phospholipids are structural components of mammalian cytoskeleton and cell membranes. Phosphatidylglycerol is an anionic lipid found in mammalian membranes in low amounts (1–2%) of the total phospholipids. Also, phosphatidylglycerol suppresses viral attachment to the plasma membrane and subsequent replication in lung cells. Phosphatidylglycerol depletion caused by over expression of cytosolic phospholipase A2α induces lipid accumulation in lung alveoli and promotes acute respiratory distress syndrome (ARDS). An exogenous-surfactant replacement has been successfully achieved in ARDS and improved oxygenation and lung mechanics. Inhibition of cytosolic phospholipase A2alpha impairs an early step of COVID-19 replication. Aim: The present study was carried out to explain the correlation between the administration of exogenous artificial surfactant as well as cytosolic phospholipase A2α inhibitors to improve oxygenation and lung mechanics and inhibit COVID-19 replication. Methods: Database research was carried out on Medline, Embase, Cochrane Library, country-specific journals, and following-up WHO reports published between December 25, 2019 – May 25, 2020. Results: Till 25 May 2020, coronavirus cases were 5,307,298, with 347,070 deathsand 2,314,849 recovered cases. According to the WHO reports, most COVID-19 deaths seen are in people who suffered from other chronic diseases characterized by phospholipidosis and phosphatidylglycerol deficiency, including hypertension, liver, heart, and lung diseases and diabetes. Phospholipases A2 (PLA2) catalyze the cleavage of fatty acids esterified at the sn-2 position of glycerophospholipids leading to enhanced inflammation and lung damage. Also, cytosolic phospholipase A2α inhibitors may reduce the accumulation of viral proteins and RNA. In addition, administration of exogenous phospholipid surfactant may help COVID-19 infected patients with ARDS to remove inflammatory mediators. Conclusion: The present study showed a relation between phosphatidylglycerol deficiency in COVID-19 infected patients with ARDS and/or chronic diseases and their mortality. These findings also showed an important approach for the prevention and treatment of COVID-19 infections by using cytosolic phospholipase A2α inhibitors and exogenous administration of a specific phospholipid surfactant.

Alternative Methods of Surfactant Administration in Preterm Infants with Respiratory Distress Syndrome: State of the Art.

For preterm infants with respiratory distress syndrome, delivery of surfactant via brief intubation (INtubate, SURfactant, Extubate; InSurE) has been the standard technique of surfactant administration. However, this method requires intubation and positive pressure ventilation. It is thought that even the short exposure to positive pressure inflations may be enough to initiate the cascade of events that lead to lung injury in the smallest neonates. In an effort to avoid tracheal intubation and positive pressure ventilation, several alternative and less invasive techniques of exogenous surfactant administration have been developed over the years. These have been investigated in clinical studies, including randomized clinical trials, and have demonstrated advantages such as a decrease in the need for mechanical ventilation and incidence of bronchopulmonary dysplasia. These newer techniques of surfactant delivery also have the benefit of being easier to perform. Surfactant delivery via pharyngeal instillation, laryngeal mask, aerosolization, and placement of a thin catheter are being actively pursued in research. We present a contemporary review of surfactant administration for respiratory distress syndrome via these alternative methods in the hope of guiding physicians in their choices for surfactant application in the neonatal intensive care unit.

Enhanced INSURE (ENSURE): an updated and standardised reference for surfactant administration.

There is no firm consensus about the optimal technique for the administration of exogenous surfactant in preterm neonates, and different techniques may be equally effective. The intubation-surfactant-extubation (INSURE) procedure has not been fully described, and important details, such as duration and mode of ventilation, remain unclear, leading to significant clinical practice variations and influencing its suitability and feasibility. Since the first INSURE description, our knowledge in respiratory care has largely progressed, but the technique has not been updated according to current evidence-based practice. Thus, our aim is to formally describe a modern way to perform INSURE, based on the current knowledge and technology, to increase its feasibility and patients’ safety. We offer ENSURE (Enhanced INSURE) as an updated and standardised technique for surfactant administration, clarifying crucial issues of the original method by applying current state-of-the-art concepts of respiratory care. We performed a cross-sectional observational study enrolling 57 preterm neonates describing ENSURE feasibility and safety. Conclusion: ENSURE can be used as a reference technique in clinical practice, teaching and research. What is Known:• There is no consensus about the optimal method for surfactant administration. INSURE technique has been originally described many years ago without considering modern principles of neonatal respiratory care and the available state-of-the-art technology.What is New:• We here describe a modern way to perform INSURE, based on the current knowledge and technology. We called it ENSURE (Enhanced INSURE) and clarified crucial points of the original technique, in light of the current knowledge. We verified feasibility and safety of ENSURE in a cross-sectional observational study enrolling 57 preterm neonates.Supplementary informationThe online version contains supplementary material available at 10.1007/s00431-021-04301-x.

Клінічний випадок тяжкої коронавірусної інфекції в дитини 6-місячного віку

Nowadays, the creation of treatment protocols for young children with COVID-19 is especially relevant, as some issues of pathogenesis and genetic determinism of severe lung damage are still unclear. COVID-19-induced respiratory distress syndrome is a predictable severe complication that requires early diagnosis and proper treatment. Given the pathogenetic mechanism of lung damage in COVID-19, surfactant replacement therapy may be useful in the treatment of this cohort of patients. Clinical case. A clinical case of severe coronavirus infection caused by SARS-CoV-2 in a 6-month-old child is presented. The course of the disease was accompanied by severe damage to the lung parenchyma with the development of acute respiratory distress. The examination of the patient confirmed the genetic determinism of severe COVID-19, polymorphic risk alleles of the genes GSTM1, GSTP1, SFTP-B. The child's treatment included not only long-term mechanical ventilation, but also surfactant replacement therapy. The child recovered and was discharged without signs of respiratory failure. Conclusions. This clinical case demonstrates the association of genetic polymorphism with severe virus-induced lung damage. Because severe respiratory failure in COVID-19 is likely to be due to the development of acute respiratory distress syndrome, administration of exogenous surfactant should be considered as a possible treatment option. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: COVID-19, children, virus-induced respiratory distress syndrome, gene polymorphism, surfactant administration.

Exogenous pulmonary surfactant in COVID-19 ARDS. The similarities to neonatal RDS suggest a new scenario for an ‘old’ strategy

Acute respiratory distress syndrome (ARDS) related to SARS-CoV-2 infection has some unusual characteristics that differentiate it from the pathophysiology described in the more ‘typical’ ARDS. Among multiple hypotheses, a close...

Pulmonary Hemorrhage in the Neonate.

Pulmonary hemorrhage (PH) is a pathology associated with significant morbidity and mortality, particularly among preterm infants in the NICU. The diagnosis is made when hemorrhagic secretions are aspirated from the trachea concurrent with respiratory decompensation that necessitates intubation or escalated support. The implementation of mechanical ventilation and widespread exogenous surfactant administration have significantly reduced respiratory morbidities. However, when PH develops, death remains the most common outcome. Treatment for PH remains primarily supportive; thus, a thorough understanding of underlying disease processes, manifestations, diagnostic testing, and current evidence is vital to enable early identification and proactive management to reduce morbidity and mortality.

Surfactant lung delivery with LISA and InSurE in adult rabbits with respiratory distress.

BackgroundIn preterm infants, InSurE (Intubation–Surfactant–Extubation) and LISA (less invasive surfactant administration) techniques allow for exogenous surfactant administration while reducing lung injury associated with mechanical ventilation. We compared the acute pulmonary response and lung deposition of surfactant by LISA and InSurE in surfactant-depleted adult rabbits.MethodsTwenty-six spontaneously breathing surfactant-depleted adult rabbits (6–7 weeks old) with moderate RDS and managed with nasal continuous positive airway pressure were randomized to 3 groups: (1) 200 mg/kg of surfactant by InSurE; (2) 200 mg/kg of surfactant by LISA; (3) no surfactant treatment (Control). Gas exchange and lung mechanics were monitored for 180 min. After that, surfactant lung deposition and distribution were evaluated monitoring disaturated-phosphatidylcholine (DSPC) and surfactant protein C (SP-C), respectively.ResultsNo signs of recovery were found in the untreated animals. After InSurE, oxygenation improved more rapidly compared to LISA. However, at 180’ LISA and InSurE showed comparable outcomes in terms of gas exchange, ventilation parameters, and lung mechanics. Neither DSPC in the alveolar pool nor SP-C signal distributions in a frontal lung section were significantly different between InSurE and LISA groups.ConclusionsIn an acute setting, LISA demonstrated efficacy and surfactant lung delivery similar to that of InSurE in surfactant-depleted adult rabbits.Impact Although LISA technique is gaining popularity, there are still several questions to address. This is the first study comparing LISA and InSurE in terms of gas exchange, ventilation parameters, and lung mechanics as well as surfactant deposition and distribution.In our animal study, three hours post-treatment, LISA method seems to be as effective as InSurE and showed similar surfactant lung delivery.Our findings provide some clarifications on a fair comparison between LISA and InSurE techniques, particularly in terms of surfactant delivery. They should reassure some of the concerns raised by the clinical community on LISA adoption in neonatal units.

Does surfactant nebulization prevent early intubation in preterm infants? A protocol for a systematic review and meta-analysis

BackgroundRespiratory distress syndrome (RDS) is the most common cause of respiratory failure in preterm infants. Treatment consists of respiratory support and exogenous surfactant administration. Commonly, surfactant is administered intratracheally. However, this requires airway instrumentation and subsequent fluid instillation which may be harmful. Surfactant nebulization (SN) may offer a safe and effective alternative for surfactant administration, but the clinical efficacy is not yet established. Thus, this systematic review and meta-analysis of randomized controlled trials will summarize the available evidence to determine the effectiveness and safety of SN for the prevention of intubation and subsequent mechanical ventilation at 72 h after birth.MethodsA systematic literature search in Medline, Embase, and The Cochrane Library will be performed, and all randomized controlled trials (RCTs) and quasi-RCTs from published articles, presentations, and trial registries will be included in this meta-analysis. Titles and abstracts of all records identified in the search will be screened by two reviewers independently.Data on preterm infants (≤ 37 weeks) receiving nebulized surfactant in the first 72 h after birth for the treatment or prevention of RDS will be evaluated. Primary outcome is the intubation rate by 72 h after birth, and secondary outcomes include peridosing safety effects as well as major neonatal morbidities.Risk of bias will be assessed using the revised Cochrane ROB tool, and subgroup analyses will be performed to evaluate potential confounding factors. Publication bias will be assessed by examining a funnel plot. The meta-analysis will be performed using a fixed-effects model.DiscussionThis review will provide an evidence-based tool for information about surfactant nebulization, illustrating the current knowledge and hopefully revealing potential novel avenues for researchers and clinicians alike.Systematic review registrationThis review is registered with the publicly available resource PROSPERO (CRD42020175625).

Timing of Antenatal Steroid Administration and Effects on the Newborn Infant: A Retrospective Study.

The timing of antenatal steroids (ANS) on short- and long-term effects on newborn infants was evaluated. This study was conducted at the University of Cincinnati Medical Center Level-III Neonatal Intensive Care Unit by reviewing the medical records of all women with history of ANS exposure from January 2015 to December 2018. We compared outcomes of newborns delivered within the ideal therapeutic window of 24 hours to 7 days (within window [WW]) after administration to those exposed and delivered outside the therapeutic window (outside window primary group [OWP]). Outcomes included anthropometrics, blood sugars, thyroid hormone profile, and neonatal morbidities. A total of 669 patients were identified as having received at least two doses of ANS. Two-thirds of them delivered within the ideal therapeutic window. Significant differences were found in anthroprometrics including lower birth weight, shorter length, and smaller head circumferences in those born within the window compared with those outside the window. Derangements in glucose homeostasis requiring treatment and elevations of thyroid stimulating hormone (TSH) were seen in infants born outside the ideal therapeutic window compared with those born within the therapeutic window. No differences were found in neonatal morbidities including severe intraventricular hemorrhage (sIVH), necrotizing enterocolitis (NEC), need for resuscitation, exogenous surfactant administration, continuous positive airway pressure (CPAP), mechanical ventilation, bronchopulmonary dysplasia (BPD), or periventricular leukomalacia (PVL). After controlling for selected covariates, only birth length was different between the groups. Effects on anthropometrics, glucose homeostasis, and thyroid function support the need to develop new or refine existing risk stratification systems to time the administration of antenatal steroids. Better targeting of women and fetuses may confer the benefits of systemic corticosteroids while mitigating the risks of adverse effects. · The timing of antenatal steroids on short and long-term effects on newborn infants was evaluated.. · Differences were found in anthroprometrics, glucoses, and thyroid function.. · No differences were found in neonatal morbidities..