Surfactant Administration Research Articles

Serum levels of vitamin D in preterm neonates and its association with respiratory distress syndrome

Objectives: Prematurity and related respiratory distress syndrome (RDS) is the major cause of mortality among neonates in India. Although some studies were showing an association between vitamin D and lung maturation, conclusive evidence was not found yet. The objective of this study was to assess the serum vitamin D in preterm neonates and to determine its possible association with RDS. Material and Methods: A case–control study in which the preterm neonates <37 weeks of age and <2 kg birth weight admitted to neonatal intensive care unit and in postnatal wards in a tertiary care center were included and divided as cases-those with RDS and controls-those without RDS. Two milliliters of whole blood samples were collected from the study population for 25 (OH) D levels. Results: (1) RDS was predominantly seen in <32 weeks (<30 and 30–31 weeks) when compared with the other two gestational age groups. (2) The mean serum vitamin D levels in cases (RDS) were lower compared to controls (non-RDS) (6.97 ± 3.24 in cases vs. 17.08 ± 4.15 in controls). (3) A significant difference in vitamin D levels was obtained among those on a mechanical ventilator and received surfactant administration compared to those who were not on a mechanical ventilator or administered surfactant (P = 0.001 and 0.003). (4) A significant association between vitamin D and adequacy of maternal vitamin D-rich food intake and sunlight exposure was found to be present (P < 0.001 and 0.018). (5). Serum levels of vitamin D were found to be lower (3.3 ± 1.6 ng/mL) in cases who died during the hospital stay compared to those who survived (8.4 ± 2.6 ng/mL), (P < 0.001). Conclusion: A significant difference in vitamin D concentration between preterms with respiratory distress syndrome and those without RDS was reflected in our study. And we also noted low serum vitamin D levels associated with poor outcome.

Outcome of Surfactant-Administration in Neonates with “Meconium-Aspiration-Syndrome”

Background: Combined Military Hospital in Rawalpindi, surfactant treatment to newborns with meconium aspiration syndrome (MAS) was studied for its effectiveness. 100 newborns with MAS who underwent surfactant treatment between [30 June] 2021 and [30 July] 2022 were a part of this prospective trial. Mortality, the need for oxygen, the demand for mechanical ventilation, and the duration of hospital stay were the main outcome measures. The frequency of pneumothoraxes used as the secondary outcome indicator. The study's findings demonstrated that the administration of surfactants considerably decreased mortality [03%] vs [10%] oxygen consumption [50%] vs. [71%], the need for mechanical breathing [20%] vs. [45%], and hospital stay [05-06] days vs. [08-05] days. Additionally, there was a considerable reduction in the incidence of pneumothorax [10%] vs. [15%]. These results imply that the use of surfactants might lessen the mortality and morbidity linked to MAS in newborns. Aim: Combined Military Hospital Rawalpindi's newborns with meconium aspiration syndrome (MAS) were the subject of this research to determine the effects of surfactant treatment. It evaluated both the treatment's main and secondary results. Methods: The Department of Neonatology at the Combined Military Hospital in Rawalpindi performed this prospective research on a sample of hundred newborns with MAS who underwent surfactant treatment between [June 30], 2021, and [July 30] 2022. Mortality, the need for oxygen, the demand for mechanical ventilation, and the duration of hospital stay were the main outcome measures. The frequency of pneumothoraxes used as the secondary outcome indicator. Results: The study's findings demonstrated that the administration of surfactants considerably decreased mortality [03%] vs [10%], oxygen consumption [50%] vs [71%], the need for mechanical breathing [20%] vs [45%] and hospital stay [5-6 days] vs [8-5 days]. Additionally, there was a considerable reduction in the incidence of pneumothorax (10% vs. 15%). Conclusion: the use of surfactants might lessen the mortality and morbidity linked to MAS in newborns. Keywords: Surfactant, Neonates, Results, Meconium Aspiration Syndrome

Patent ductus arteriosus (PDA) and response to late surfactant treatment in premature infants.

To determine the clinical/echocardiography (ECHO) phenotype of patients with hypoxic respiratory failure (HRF) and response to late surfactant, according to patent ductus arteriosus (PDA) status. This retrospective study included infants ≤26+6 weeks gestation who received ≥1 surfactant dose after 6 postnatal days and where PDA status was available by ECHO. Response to surfactant was appraised based on change in respiratory severity score over 48 h. The relationship between PDA status and response to surfactant was evaluated via univariate analysis. We studied late surfactant (n = 71 doses) administration in 35 preterm infants born at a mean weight and GA at birth were 595 g (508, 696) and 23.3 (22.7, 25) weeks, respectively of whom 16 (46%) had a diagnosis of PDA. Positive response to late surfactant treatment was independently associated with absence of PDA [OR 26 (2, 334), p = 0.01] whereas presence of PDA was independently associated with negative response [OR 12 (1.1, 126), p = 0.04]. In neonates ≤26+6 weeks gestation, with HRF, response to surfactant after postnatal day 6 is influenced by PDA status. Future trials should consider PDA status which may enhance diagnostic precision and refine patient selection for late surfactant treatment.

Nasal high flow therapy for primary respiratory support in preterm infants.

Nasal high flow therapy for primary respiratory support in preterm infants.

Curriculum and assessment tool for less invasive surfactant administration: an international Delphi consensus study

BackgroundTraining and assessment of operator competence for the less invasive surfactant administration (LISA) procedure vary. This study aimed to obtain international expert consensus on LISA training (LISA curriculum (LISA-CUR)) and assessment (LISA assessment tool (LISA-AT)).MethodsFrom February to July 2022, an international three-round Delphi process gathered opinions from LISA experts (researchers, curriculum developers, and clinical educators) on a list of items to be included in a LISA-CUR and LISA-AT (Round 1). The experts rated the importance of each item (Round 2). Items supported by more than 80% consensus were included. All experts were asked to approve or reject the final LISA-CUR and LISA-AT (Round 3).ResultsA total of 153 experts from 14 countries participated in Round 1, and the response rate for Rounds 2 and 3 was >80%. Round 1 identified 44 items for LISA-CUR and 22 for LISA-AT. Round 2 excluded 15 items for the LISA-CUR and 7 items for the LISA-AT. Round 3 resulted in a strong consensus (99–100%) for the final 29 items for the LISA-CUR and 15 items for the LISA-AT.ConclusionsThis Delphi process established an international consensus on a training curriculum and content evidence for the assessment of LISA competence.ImpactThis international consensus-based expert statement provides content on a curriculum for the less invasive surfactant administration procedure (LISA-CUR) that may be partnered with existing evidence-based strategies to optimize and standardize LISA training in the future.This international consensus-based expert statement also provides content on an assessment tool for the LISA procedure (LISA-AT) that can help to evaluate competence in LISA operators. The proposed LISA-AT enables standardized, continuous feedback and assessment until achieving proficiency.

The Role of Lung Ultrasonography Scoring in Predicting the Need for Surfactant Therapy in Neonates, With Respiratory Distress Syndrome

Objective: Surfactant administration has an essential role in the treatment of neonatal respiratory distress syndrome (RDS). This is coupled with the capability of a lung sonography scoring system (LUS scoring) in assessing neonatal lungs with RDS, makes evaluating the role of such a scoring system important in deciding to use surfactant therapy. Materials and Methods: This cross-sectional study was conducted on neonates with RDS, at a gestational age of more than 30 weeks. Using a high-frequency ultrasound transducer, neonates’ results were assessed by a radiologist, and then LUS scoring was determined in both groups, with and without the need for surfactant therapy. Results: The mean LUS scoring in the two groups was 9.08 ± 3.09 and 4.12 ± 2.56, respectively, which indicated a significant difference. The LUS scoring had a higher ability to predict the need for surfactant treatment, based on a receiver operating curve analysis. The best diagnostic cutoff point, for LUS scoring in predicting the need for surfactant treatment, was 6 in neonates 30–32 weeks and 7 in neonates 32–34 weeks. The use of LUS scoring had a sensitivity of 85.1%, 84% and a specificity of 87.2%, 88%, respectively. Conclusion: The LUS scoring may be used to help in the predicted need for surfactant therapy, in neonates with RDS.

Neonatal Outcomes Associated With Personalized Text Messages for Diabetes Self-Management in Pregnancy [ID: 1373396

INTRODUCTION: The objective was to determine whether providing individualized text messages regarding diabetes management improved compliance with care and pregnancy outcomes. METHODS: Institutional review board committee approval was obtained for the study. Pregnant women with type 2 (T2) and gestational diabetes (GDM) were randomized into two groups. The “contact-control” group was enrolled in the Text4baby program, which provides nonpersonalized educational text messages throughout pregnancy. The intervention group (Text4diabetes) received individualized text messages regarding upcoming appointments, current insulin regimen, and encouragement to keep and submit glucose logs for review. The primary outcome is compliance (data not yet analyzed). This analysis assesses neonatal outcomes, including perinatal loss (>24 weeks), delivery gestational age (GA), arterial cord pH less than 7.1, 5-minute Apgar less than 7, large-for-gestational-age (LGA) status, need for glucose supplementation, intubation, and surfactant administration. RESULTS: One hundred forty-four women with T2 or GDM were randomized. Both groups had similar numbers of women with T2 diabetes (33% and 31%) and history of GDM in prior pregnancy (21% and 19%). The Text4diabetes group had fewer deliveries less than 35 weeks, fewer LGA infants, and fewer surfactant administrations. A composite of adverse neonatal outcomes, including LGA status, delivery less than 35 weeks GA, arterial cord pH less than 7.1, and need for surfactant administration, showed fewer adverse outcomes in the Text4diabetes group. No findings, however, reached statistical significance. CONCLUSION: Text messages aimed at improving compliance with diabetes care in pregnancy did not significantly affect neonatal outcomes. Correlation with compliance results is needed to see whether improved compliance improved neonatal outcomes.

Comparison of flexible nasogastric tube and semi-rigid catheter during less invasive surfactant administration.

Various flexible and semi-rigid catheter techniques have been reported for surfactant delivery during less invasive surfactant administration (LISA) in preterm infants. Data on the effect of catheter selection on procedural success rates and adverse events are limited. Our objective was to compare the rates of success and adverse events of LISA performed with nasogastric tube and semi-rigid catheter. This was a post-hoc analysis of data from a quality improvement project. LISA was performed according to the standardized local protocol. Baseline characteristics, data on performance of LISA, degree of difficulty in laryngoscopy and vital parameters after the initiation of LISA were collected and outcomes were compared between groups. Fifty-six infants were included (21 with nasogastric tube, and 35 with semi-rigid catheter). Procedure success rate (defined as a single LISA attempt resulting in intratracheal administration of the planned dose of surfactant), incidence of adverse events, heart rate and oxygen saturation values and outcomes did not differ significantly between the two groups. When using a nasogastric tube for LISA, a significantly higher fraction of inspired oxygen was needed in the 3rd (0.62 vs. 0.48, P=0.024), 4th (0.61 vs. 0.37, P<0.001) and 5th minute (0.48 vs. 0.37, P=0.001) to maintain normal oxygen saturations. Use of the semi-rigid catheter was associated with better oxygenation during and shortly after the procedure. Our results may help neonatal units to develop local guidelines.

Structural and haemodynamic evaluation of less invasive surfactant administration during nasal intermittent positive pressure ventilation in surfactant-deficient newborn piglets.

The most recent approaches to the initial treatment of respiratory distress syndrome (RDS)- involve non-invasive ventilation (NIV) and less-invasive surfactant (SF) administration (LISA). Combining these techniques has been proven a useful treatment option for SF-deficient neonates. The objective of this study was to explore the impact on the brain (using cerebral near infrared spectroscopy, NIRS) of different LISA methods during NIV, using nasal intermittent positive pressure ventilation (NIPPV) for treating neonatal RDS. For this, we used five groups of spontaneously breathing newborn piglets (n = 6/group) with bronchoalveolar lavage (BAL)-induced respiratory distress which received NIPPV only (controls), poractant-alfa using the INSURE-like method (bolus delivery) followed by NIPPV, or poractant-alfa using one of three LISA devices, 1) a nasogastric tube (NT), 2) a vascular catheter (VC) or 3) the LISAcath® catheter. We assessed pulmonary, hemodynamic and cerebral effects, and performed histological analysis of lung and brain tissue. Following BALs, the piglets developed severe RDS (pH<7.2, PaCO2>70 mmHg, PaO2<70 mmHg, dynamic compliance<0.5 ml/cmH2O/kg at FiO2 = 1). Poractant-alfa administration using different LISA techniques during NIPPV was well tolerated and efficacious in newborn piglets. In our study, although all groups showed normal physiological ranges of total lung injury score and biochemical lung analysis, VC and LISAcath® catheters were associated with better values of lung compliance and lower values of lung damage than NIPPV, NT or INSURE-like methods. Moreover, neither of the SF administration methods used (LISA or INSURE-like) had a significant impact on the histological neonatal brain injury score. Of note, the LISAcath® has been recently withdrawn from the market.

Surfactant delivery via thin catheter in preterm infants: A systematic review and meta-analysis.

Surfactant administration via a thin catheter (STC) is an alternative to surfactant administration post endotracheal intubation in preterm infants with respiratory distress syndrome (RDS); however, the benefits particularly in infants <29 weeks' gestation and the neurodevelopmental outcomes remain unclear. Thus, our objective was to systematically review and meta-analyze the efficacy and safety of STC compared to intubation for surfactant or nasal continuous positive airway pressure (nCPAP) in preterm infants with RDS. Medical databases were searched until December 2022 for randomized controlled trials (RCTs) assessing STC compared to controls that included intubation for surfactant or nCPAP in preterm infants with RDS. The primary outcome was bronchopulmonary dysplasia (BPD) at 36 weeks gestation in survivors. Subgroup analysis was conducted comparing STC to controls in infants < 29 weeks' gestation. The Cochrane risk of bias (ROB) tool was used and certainty of evidence (CoE) was rated according to GRADE. Twenty-six RCTs of 3349 preterm infants, in which half of the studies had low risk of bias, were included. STC decreased the risk of BPD in survivors compared to controls (17 RCTs; N = 2408; relative risk (RR) = 0.66; 95% confidence interval (CI) 0.51 to 0.85; number needed to treat for an additional beneficial outcome (NNTB) = 13; CoE: moderate). In infants < 29 weeks' gestation, STC significantly reduced the risk of BPD compared to controls (6 RCTs, N = 980; RR 0.63; 95% CI 0.47 to 0.85; NNTB = 8; CoE: moderate). Compared to controls, STC may be a more efficacious and safe method of surfactant delivery in preterm infants with RDS, including infants < 29 weeks' gestation.

Risk Factors for Pneumothorax and Its Association with Ventilation in Neonates.

The mode of ventilation that is implicated in pneumothorax is the one at the time of its diagnosis. Although there is evidence that air leak starts many hours before it is clinically evident, there are no prior studies that have investigated the association of pneumothorax with the mode of ventilation few hours before rather than at the time of its diagnosis. A retrospective case-control study was conducted in the neonatal intensive care unit (NICU) between 2006 and 2016 where cases of neonates with pneumothorax were compared with gestational age-matched control neonates without pneumothorax. Respiratory support associated with pneumothorax was classified as the mode of ventilation 6 hours before the clinical diagnosis of pneumothorax. We investigated the factors that were different between cases and controls, and between cases of pneumothorax on bubble continuous positive airway pressure (bCPAP) and invasive mechanical ventilation (IMV). Of the 8,029 neonates admitted in the NICU during the study period, 223 (2.8%) developed pneumothorax. Among these, 127 occurred among 2,980 (4.3%) neonates on bCPAP, 38 among 809 (4.7%) neonates on IMV, and the remaining 58 among 4,240 (1.3%) neonates on room air. Those with pneumothorax were more likely to be male, have higher body weight, require respiratory support and surfactant administration, and have bronchopulmonary dysplasia (BPD). Among those who developed pneumothorax, there were differences in the gestational age, gender, and use of antenatal steroids between those who were on bCPAP as compared to those on IMV. IMV was associated with increased odds of pneumothorax as compared to those on bCPAP in a multivariable regression analysis. Cases on IMV had higher incidence of intraventricular hemorrhage, retinopathy of prematurity, BPD, and necrotizing enterocolitis, as well as longer length of stay as compared to those on bCPAP. Neonates who require any respiratory support have higher incidence of pneumothorax. Among those on respiratory support, those on IMV had higher odds of pneumothorax and worse clinical outcomes as compared to those on bCPAP. · The process of air leak leading to pneumothorax in majority of neonates starts much before it is clinically diagnosed.. · It is possible to detect the air leak early in the process by subtle changes in the signs, symptoms and changes in lung function.. · True association of the ventilation associated with pneumothorax is not at the time of diagnosis of pneumothorax but few hours before it is diagnosed.. · There is higher incidence of pneumothorax in neonates on any respiratory support.. · There is significantly higher incidence of pneumothorax among neonates on invasive ventilations as compared to noninvasive ventilation after correction for all other clinical factors..

Predictive Ability of Conventional and Combined Apgar Scores versus Neonatal Resuscitation and Adaptation Score in Early Neonatal Assessment.

The aim of this study was to assess the Neonatal Resuscitation and Adaptation Score (NRAS) value compared with the conventional and combined Apgar scores in predicting neonatal morbidity and mortality. A prospective cohort study was conducted on 289 neonates delivered at the Menoufia University Hospital. Trained physicians measured conventional Apgar score, combined Apgar score, and NRAS for the neonates at 1 and 5 minutes after delivery in the delivery room. Admitted neonates were followed during their stay to detect any adverse outcomes. Morbidities such as the need for neonatal intensive care unit admission, mechanical ventilation, surfactant and inotropes administration, need for extensive phototherapy, intravenous immunoglobulin or exchange transfusion, anemia, metabolic acidosis, abnormal liver and kidney function tests, coagulopathies, hypoglycemia, development of seizures in the first 72 hours of life, and positive changes in cranial ultrasound were significantly higher in neonates who lie within low or moderate NRAS than conventional and combined Apgar scores (p < 0.05). As predictors of mortality, the low and moderate values of the NRAS had higher positive predictive values at 1 (73.91 and 30.61%) and 5 minutes (88.89 and 50.94%) than the conventional Apgar scores at 1 (49.18 and 20.53%), 5 minutes (81.25 and 41.27%) and the combined Apgar scores at 1 (35.63 and 12.45%) and 5 minutes (53.1 and 41.33%). Our study suggests that the NRAS is better than conventional and combined Apgar scores in predicting neonatal morbidity and mortality. Furthermore, a depressed 5-minute NRAS is more predictive of mortality than 1-minute score. · NRAS is better than conventional and combined Apgar scores in predicting neonatal morbidity.. · NRAS is more predictive of mortality than conventional and combined Apgar scores.. · A depressed 5-minute NRAS is more predictive of mortality than 1-minute score..

Video laryngoscopy-assisted less-invasive surfactant administration quality improvement initiative

ObjectiveTo describe the use of quality improvement methodology in transitioning from delivery of surfactant by INSURE (INtubation–SURfactant administration–Extubation) to video laryngoscope-assisted LISA (less-invasive surfactant administration) for infants with respiratory distress...

Surfactant administration during endotracheal CPAP: Feasibility, risk factors for failure and short-term outcomes of DD-SURF.

Whereas there is agreement that surfactant should be administered without mechanical ventilation, there is still a debate concerning the optimal method. DD-SURF combines the benefits of INSURE and less invasive surfactant administration (LISA). The efficacy of this approach has not been evaluated yet. Retrospective cohort study of all preterm newborns below 300/7 weeks gestational age admitted to the neonatal intensive care unit. Data on surfactant therapy, respiratory support during the first 96 h of life and neonatal morbidities until hospital discharge were collected from the electronic patient charts to evaluate the efficacy and safety of our approach. In total, 222 newborns met the inclusion criteria; 174 (78%) received surfactant in the delivery room by the DD-SURF procedure and 21 infants (10%) were not extubated after surfactant administration (Surf-and-vent group). After DD-SURF, 75% of patients did not require reintubation. Intraventricular haemorrhage and bronchopulmonary dysplasia occured more often in infants after DD-SURF failure than after successful DD-SURF. DD-SURF potentially combines the benefits of INSURE and LISA and represents a useful alternative of surfactant delivery with comparable success rates to thin-catheter surfactant administration.

Premature monochorionic monoamniotic twins have lower lung compliance at birth than matched dichorionic diamniotic twins.

Premature infants are born with immature lungs that demonstrate abnormal pulmonary function with differences in passive respiratory system compliance and resistance, and functional residual capacity. To our knowledge, no studies have evaluated differences in neonatal pulmonary function based on the type of twin gestation, or chorionicity. Given the effect of chorionicity on outcomes, we aimed to study the effect of twin type, monochorionic monoamniotic (MCMA) vs dichorionic diamniotic (DCDA), on neonatal early pulmonary function tests. In this prospective cohort study, 5 sets of DCDA twins were matched to 5 sets of MCMA twins on gestational age at delivery, latency from antenatal corticosteroid exposure, birthweight, race and gender. Mean values were compared for passive respiratory system compliance and resistance, functional residual capacity, and tidal volume. MCMA infants had a significantly lower compliance (0.64 vs 1.25 mL/cm H2O /kg; p = 0.0001) and significantly higher resistance (0.130 vs 0.087 cm H2O /mL/sec; p = 0.0003) than DCDA infants. Functional residual capacity was lower for MCMA than DCDA infants (17.5 vs 23.4 mL/kg; p = 0.17). Further, 80% of MCMA infants required intubation for surfactant administration compared to 20% of DCDA infants, indicating the clinical significance of these objective measures. Due to the matched case-control design, causality cannot be established. However, we speculate that these differences in lung function may derive from differential exposure to preterm labor and endogenous maternal corticosteroid exposure. Further study is necessary to establish the true causal relationship.

Efficacy and safety of surfactant administration by MIST and INSURE techniques in Neonates with Respiratory Distress Syndrome: A randomized controlled trial.

To measure the efficacy and safety of surfactant administered by MIST and INSURE to neonates with respiratory distress syndrome. A randomized controlled trial was conducted from June 2021 to August 2022 at the NICU of the University of Child Health Sciences, Lahore. Neonates meeting inclusion criteria i.e with RDS who worsened on nasal Continuous positive airway pressure (nCPAP) (fiO2 30%, pressure 6cmH2O) were enrolled in the study in both interventional arms (MIST, n=36 and INSURE, n=36) using simple random sampling. Data was analysed using SPSS 25. The mean age of neonates in MIST was 1.27±0.40 days and 1.23±0.48 days in INSURE cohort. Neonates with MIST (n=8) required statistically significant reduced need for IMV than INSURE (n=17) technique (P-Value 0.047). This study could not achieve significant difference in duration of mechanical ventilation (1±1.67; 1.52±1.40 days, P=0.152) and duration of nCPAP (3.27±1.65;3.67±1.64 hrs, P=0.312) in MIST versus INSURE. The second dose of surfactant was administered in fewer cases in MIST (n=2) than INSURE (n=7) (P=0.075). Risk estimation, although not significant, determined less likelihood for the pulmonary haemorrhage (0.908 than 1.095), intraventricular hemorrhage (0.657 than 1.353), administration of the second dose of surfactant (0.412 than 1.690) and greater likelihood of discharge (1.082 than 0.270) at 95% confidence interval with MIST technique. Surfactant therapy through MIST is effective and there is significantly reduced need of IMV than in INSURE. Safety profile though could not achieve statistical significance yet determines less risk of complications associated with MIST than INSURE.RCT Registration Number: TCTR20210627001.

REVIEW OF SURFACTANT DELIVERY STRATEGIES IN NEONATOLOGICAL PRACTICE

Administration of surfactant by minimally invasive techniques that promote spontaneous breathing may be safer and more effective than administration with endotracheal intubation and mechanical ventilation. At present, the use of INSURE and LISA/MIST methods is well researched and widely used, their effectiveness has been largely proven and beyond doubt. However, current trends towards greater use of non-invasive respiratory support in surfactant-deficient preterm infants have created a demand for similar non-invasive methods of administering exogenous surfactant, one of which is the potentially promising method of inhaled delivery of a substance to the lungs using a nebulizer.

Extreme prematurity-associated alterations of pulmonary inflammatory mediators before and after surfactant administration.

The role of prematurity and pulmonary inflammation in the pathogenesis of bronchopulmonary dysplasia (BPD) is very well-defined. However, there is limited knowledge about whether the level of prematurity and surfactant therapy alter the pulmonary cytokines and endothelial growth factor (VEGF). This study analyzed the VEGF and cytokines, including interleukin (IL)-1β, IL-6, IL-8, and IL-10, and tumor necrosis factor α (TNF-α) in the tracheal aspirate (TA) of preterm infants obtained before (within 2h after birth) and 10-12h after the administration of the first dose of surfactant. TA was collected from 40 infants of 35 or fewer weeks of gestation, including extremely (Group 1, n=19), very (Group 2, n=13), and moderate/late (Group 2, n=8) preterm neonates. In addition to univariate analysis, controlled regression models estimated the association of perinatal factors with the tested parameters and their role in the development of BPD. We recorded significantly lower post-partum levels of VEGF and higher IL-8, IL-1β, and TNF-α in the TA of Group 1 infants than in Group 2 and 3. Compared to the infants in Group 2 and 3, the post-surfactant increases of pulmonary VEGF, IL-8, IL-10, and TNF-α were more significant in Group 1. All tested parameters in Group 1 and 2 infants, before and after surfactant administration, were comparable. BPD was recorded in nearly 60% of the extremely preterm survivors and was significantly predicted by increased IL-8 before, and elevated TNF-α level after surfactant administration. This study indicates the association of birth at extremely preterm gestation with reduction in pulmonary VEGF and exacerbation of pro-inflammatory cytokines followed by greater elevation post-surfactant administration levels of VEGF, IL-8, TNF-α, and IL-10 than in neonates born with gestational age of 28-35 weeks.

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.

Can lung ultrasound score accurately predict surfactant replacement? A systematic review and meta-analysis of diagnostic test studies.

Clinical and radiographic criteria are traditionally used to determine the need for surfactant therapy in preterm infants. Lung ultrasound is a bedside test that offers a rapid, radiation-free, alternative to this approach. To conduct a systematic review and meta-analysis to determine the accuracy of a lung ultrasound score (LUS) in identifying infants who would receive at least one surfactant dose. Secondary aims were to evaluate the predictive accuracy for ≥2 doses and the accuracy of a different image classification system based on three lung ultrasound profiles. PubMed, SCOPUS, Biomed Central, and the Cochrane library between January 2011 and December 2021 were searched. Full articles enrolling preterm neonates who underwent lung ultrasound to predict surfactant administration were assessed and analyzed following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols(PRISMA-P) and QUADAS-2 guidelines. Seven prospective studies recruiting 697 infants met the inclusion criteria. Risk of bias was generally low. Oxygen requirement, clinical and radiographic signs of respiratory distress syndrome were used as reference standards for surfactant replacement. The summary receiver operator characteristic(sROC) curve for LUS predicting first surfactant dose showed an area under the curve(AUC) = 0.88 (95% confidence interval [CI]: 0.82-0.91); optimal specificity and sensitivity (Youden index) were 0.83 and 0.81 respectively. Pooled estimates of sensitivity, specificity, diagnostic odds ratio, negative predictive value,and positive predictive valuefor LUS predicting the first surfactant dose were 0.89 (0.82-0.95), 0.86 (0.78-0.95), 3.78 (3.05-4.50), 0.92 (0.87-0.97), 0.79 (0.65-0.92). The sROC curve for the accuracy of Type 1 lung profile in predicting first surfactant dose showed an AUC of 0.88; optimal specificity and sensitivity were both 0.86. Two studies addressing the predictive accuracy of LUS for ≥2 surfactant doses had high heterogeneity and were unsuitable to combine in a meta-analysis. Despite current significant variation in LUS thresholds, lung ultrasound is highly predictive of the need for early surfactant replacement. This evidence was derived from studies with homogeneous patient characteristics and low risk of bias.