Dose Of Surfactant Research Articles

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.

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.

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.

Establishment and evaluation of nomogram for predicting intraventricular hemorrhage in neonatal acute respiratory distress syndrome

BackgroundIntraventricular hemorrhage (IVH) is the most common type of brain injury in newborns, especially in newborns with Neonatal acute respiratory distress syndrome (ARDS). IVH can cause brain parenchyma damage and long-term neurological sequelae in children. Early identification and prevention of sequelae are essential. This study aims to establish a predictive nomogram for the early prediction of IVH in newborns with ARDS.MethodsFrom 2019 to 2021, we collected data from 222 infants diagnosed with ARDS in the Department of Neonatology, First Affiliated Hospital of Xinjiang Medical University. Infants have been randomly assigned to the training set (n = 161) or the validation set (n = 61) at a ratio of 7:3. Variables were screened using the Least Absolute Contract and Selection Operator (LASSO) regression to create a risk model for IVH in infants with ARDS. The variables chosen in the LASSO regression model were used to establish the prediction model using multivariate logistic regression analysis.ResultsWe recognized 4 variables as independent risk factors for IVH in newborns with ARDS via LASSO analysis, consisting of premature rupture of membranes (PROM), pulmonary surfactant (PS) dosage, PH1 and Arterial partial pressure of oxygen (PaO21). The C-Index for this dataset is 0.868 (95% CI: 0.837–0.940) and the C index in bootstrap verification is 0.852 respectively. The analysis of the decision curve shows that the model can significantly improve clinical efficiency in predicting IVH. We also provide a website based on the model and open it to users for free, so that the model can be better applied to clinical practice.ConclusionIn conclusion, the nomogram based on 4 factors shows good identification, calibration and clinical practicability. Our nomographs can help clinicians make clinical decisions, screen high-risk ARDS newborns, and facilitate early identification and management of IVH patients.

Amelioration of Biogas Production from Waste-Activated Sludge through Surfactant-Coupled Mechanical Disintegration

The current study intended to improve the disintegration potential of paper mill sludge through alkyl polyglycoside-coupled disperser disintegration. The sludge biomass was fed to the disperser disintegration and a maximum solubilization of 6% was attained at the specific energy input of 4729.24 kJ/kg TS. Solubilization was further enhanced by coupling the optimum disperser condition with varying dosage of alkyl polyglycoside. The maximum solubilization of 11% and suspended solid (SS) reduction of 8.42% were achieved at the disperser rpm, time, and surfactant dosage of 12,000, 30 min, and 12 μL. The alkyl polyglycoside-coupled disperser disintegration showed a higher biogas production of 125.1 mL/gCOD, compared to the disperser-alone disintegration (70.1 mL/gCOD) and control (36.1 mL/gCOD).

Fabrication of stable Pickering double emulsion with edible chitosan/soy β-conglycinin complex particles via one-step emulsification strategy

Double emulsion is the most common multiple emulsion with compartmentalized internal structure. It can be used for delivery of both hydrophilic and hydrophobic bioactives and fat reduction in foods. However, conventional approach for stable double emulsion preparation often requires high dosage of synthetic surfactants (e.g., polyglycerol polyricinoleate, PGPR) and complicated two-step emulsification process. Herein, we report a facile approach to create stable double emulsion using particular emulsifier of edible chitosan/soy β-conglycinin (7S) complex nanoparticles via one-step emulsification. By modulating chitosan/7S complex ratio of particles and algal oil content in oil phase, water-in-oil-in-water (W/O/W) Pickering double emulsion was generated in most cases. The dominant mechanism for one-step generation of Pickering double emulsion can be attributed to the polyunsaturated fatty acids (PUFA) in algal oil. The binding of PUFA on particle surface contributes to hydrophobization of the chitosan/7S complex nanoparticles, leading to stabilization of W/O interface. Moreover, stability of the resultant Pickering double emulsions is correlated to particle contact angle. When using nanoparticles with chitosan/7S complex ratio of 1:2 and oil phase containing 40 wt% algal oil, particle contact angle at O/W interface is near 90°, which is the optimum condition to produce highly stable Pickering double emulsion. This facile approach for the fabrication of stable double emulsion is promising for a wide range of applications, particularly in food field.

Review on Microemulsions for Conformance Improvement Technology: Fundamentals, Design Considerations, and Perspectives

The area of conformance improvement technology (CIT) encompasses the application of a myriad range of conventional fluids, including polymers, gels, foams, polymer-enhanced gels and foams, bacteria, and emulsions. However, these routes show operational limitations in terms of chemical degradation, thermal degradation, formation damage, susceptibility to high salinity, and segregation within pore spaces. To mitigate these problems, it is necessary to employ conformance agents that can be effectively tuned for a wide variety of reservoir conditions. Microemulsions are a promising class of fluids that exhibit thermodynamic stability, robust structure, and tunable properties. The concept of this research is to inject the optimal (correct) dosage of surfactants, which form micelles with in situ hydrocarbons to form microemulsions. Microemulsions are characterized by direct and reverse micelles, which contribute to their intermolecular interactions responsible for fluid stability and propagation under dynamic shear conditions. Design and reservoir considerations must comprise of a number of factors, namely, salinity, pH, temperature, slug concentration, and fluid activation/placement. An optimal microemulsion can be identified by understanding the flow mechanisms while accounting for mobility control, rock permeability and heterogeneity, thief zone permeabilities, and the presence of anomalies. It has been established in this review that microemulsions help plug the high permeability pore throats via a combination of the “Jamin effect” and viscosity modification. By adoption of a proper workflow design, the reservoir may be tuned via the introduction of microemulsions to suit the needs of the industry. However, considerable research is still needed to validate the design aspects and application of microemulsions for conformance improvement.

Clinical characteristics and outcomes in neonates with perinatal acute respiratory distress syndrome in China: Anational, multicentre, cross-sectional study.

Neonatal acute respiratory distress syndrome (NARDS) was defined in 2017 and the epidemiological data remain unknown. Our objective was to explore aetiological factors, clinical characteristics and outcomes in patients with perinatal NARDS. A multicentre, prospective, cross-sectional study was performed in 58 tertiary neonatal intensive care units in China from Jan 1, 2018 to June 30, 2019. Neonates diagnosed with NARDS were included. Primary outcomes were aetiological factors, clinical characteristics and outcomes. Binary logistic regression and multivariate cox proportional regression were performed to identify independent predictors for bronchopulmonary dysplasia (BPD) and/or death or single death. This study was registered with ClinicalTrials.Gov, NCT03311165. Among 70,013 admitted neonates, the incidence of NARDS was 1.44% (1005). The cumulative incidences were 65.6%, 86.7%, 94.1% within one, two and three days after birth. The median gestational age and birth weight were 36.4 weeks and 2700g. Three main aetiological triggers included pneumonia (58.1%), asphyxia (24.3%) and early-onset sepsis (EOS) (21.3%). BPD and/or death was observed in 213 (21.2%) infants, consisting 104 (10.3%) BPD and 126 (12.6%) deaths. The numbers of mild, moderate and severe NARDS were 537 (53.4%), 286 (28.4%) and 182 (18.2%). Two or more doses of surfactant was associated with increased mortality as compared with one or less doses of surfactant (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.20-3.10, P=0.006). Similarity also appeared in the comparison between EOS and non-EOS triggers (OR 1.57, 95% CI 1.06-2.33, P=0.023). NARDS incidence was 1.44% and the three main aetiologies were pneumonia, asphyxia and EOS. The cumulative incidences were 65.6%, 86.7%, and 94.1% within one, two and three days after birth. Our results suggested that two or more doses of surfactant increased mortality compared with one or less doses of surfactant. The National Clinical Research Center of China and Clinical Medical Study Program of Children's Hospital of Chongqing Medical University (NCRC-2019-GP-13) and Natural Science Foundation of Chongqing (cstc2020jcyj-msxmX0197).

Demulsification of water in oil emulsion via non– ionic surfactants: Statistical modeling and optimization

The crude oil present in its natural background cannot be used right away- the emulsions and dissolved substances present in the oil can result in undesirable chemical reactions during processing, unwanted by-products, damage of refinery equipment like distillation columns, and reduced quality of the end products. The basic principle of demulsification is to break down the emulsifying film formed around the water droplets immersed in oil. Several methods can be used to achieve this, which can be used singly or combined with other methods. This research was done to stabilize and optimize the demulsification process of water in oil emulsion using non-ionic surfactants. A combination of experimental and numerical analysis was used to study the impact of parameters like dosage of surfactant, solvent concentration, pressure, temperature, and retention time on the dehydration efficiency of the emulsion. The results established the findings of theoretical studies that the surfactant temperature, time, and dosage are 0.251 mg/L, 25.113 mL, 1.018 m/s2, 68.188 °C, 5.535 min, 8.025% significant in the dehydration of the emulsion. These factors enable more excellent removal of the dispersed medium, water, from the oil emulsion. This is calculated by analyzing the change in the dehydration percentage for different values of parameters.

Who needs a second dose of exogenous surfactant?

Who needs a second dose of exogenous surfactant?

The Preparation of Apigenin Nanoparticles and the Study of Their Anti-Inflammatory and Anti-Tumor Activities In Vitro

Apigenin (API) has many biological activities, but its poor solubility limits its clinical application. In this research, API nanoparticles were prepared by the liquid antisolvent precipitation (LAP) technique, which effectively improved the solubility and bioavailability of API. Through the design of a single-factor test, the effects of the type and dosage of surfactants, API concentration, the antisolvent to solvent volume ratio, the speed and time of stirring, the temperature of precipitation, and the dropping speed on the MPS (mean particle size) of API nanosuspension were carried out. The optimum technological conditions were determined as follows: 5 mg/mL of tween 80 as a surfactant, 20 mg/mL of API, an antisolvent/solvent volume ratio of 10, a 1200 r/min stirring speed for 5 min, a 45 °C precipitation temperature, and a 1 mL/min dropping speed. Under the optimum conditions, we obtained API nanosuspension with 170.5 nm MPS and then it was freeze-dried to obtain the API nanoparticles. Moreover, we characterized the API nanoparticles by SEM, FTIR, XRD, DSC, and TG. Results showed that although API nanoparticles transformed into an amorphous form, their internal chemical structure had not been changed and had a higher solubility. Finally, API nanoparticles’ anti-inflammatory activities were evaluated by observing the effect of API on nitric oxide (NO) production and IL-10 production toward RAW264.7 cells induced by lipopolysaccharide (LPS). Moreover, the anti-tumor effect of API was determined by testing cell viability and apoptosis. The results suggested that API nanoparticles exhibited much better anti-inflammatory and anti-tumor activities compared to raw API.

Less invasive surfactant administration via infant feeding tube versus InSurE method in preterm infants: a randomized control trial

There is growing evidence that less invasive surfactant administration (LISA) is a better alternative to the standard Intubate-surfactant-extubate (InSurE) procedure in spontaneously breathing preterm infants with RDS. The infant feeding tube is easily available and cost-effective in comparison to special catheters used for surfactant administration in various studies on LISA and cost-effective health care is the need of the hour for countries like ours which are Low and middle-income countries(LMICs).The present study was planned to compare the total duration of respiratory support in preterm babies between 26 to 34 weeks of gestation with RDS requiring surfactant therapy administered by LISA technique using an infant feeding tube or InSurE method. In this unblinded randomised controlled trial, 150 infants were allocated to LISA (n = 74) or InSurE group (n = 76). An 8F feeding tube was used for surfactant delivery in the LISA group. The primary outcome was the total duration of respiratory support required and secondary outcomes included the proportion of babies developing BPD, IVH, PDA, NEC, ROP, air leaks, CPAP failure, and those requiring a repeat dose of surfactant along with the duration of hospitalization, time to regain birth weight and Death. The baseline variables including birth weight and gestation age were similar in the two groups. Nearly 27% of the mothers did not receive any dose of antenatal steroids (ANS) while around 37% of the mothers received complete course of ANS. A high proportion of babies (57%) were delivered by cesarean section. Intrapharyngeal reflux was significantly more in babies who received surfactant with the LISA method in comparison to InSurE technique (32% v/s 3%, p < 0.001). There was no statistically significant difference in the primary outcome of the total duration of respiratory support in both groups with a median duration of 120 h, 95% CI (69–235), and p = 0.618. The need for invasive mechanical ventilation was significantly lower in the LISA group (p = 0.017) with RR (95% CI) 0.498 (0.259–0.958). The rate of CPAP failure was significantly lower in the LISA group (p = 0.005) with RR (95% CI) 0.55 (0.34–0.89). In this study, the total duration of hospital stay was reduced in the LISA group (19 days) compared to InSurE group (26 days), although the same was not statistically significant. LISA with an 8F feeding tube is feasible and an effective strategy for surfactant administration which resulted in a significant reduction in CPAP failure and the need for invasive mechanical ventilation.Trial registration: www.ctri.nic.in id CTRI/2020/05/025360. Trial was registered at CTRI on 26/05/2020. First case of trial was enrolled on 28/05/2020.

Froth flotation separation of phosphate ore using a novel hammer-like amidoxime surfactant

Phosphate fertilizer, as a necessary nutrient for crops in agriculture, plays a vital role in addressing global food security concerns. The source of phosphate fertilizer is mainly obtained through the production of phosphate ore, which has caused widespread concern. However, in the traditional process, the low production efficiency and high dosage of common surfactants have severely restricted the development and utilization of phosphate rock resources. In this work, a new designed hammer-like amidoxime surfactant (DPA) was characterized and introduced as an outstanding collector to recover high quality phosphate ore. The micro-flotation tests indicated that DPA had more excellent collecting ability and selectivity(The phosphorite recovery was always lower than 15%) than common monomolecular collector 1-dodecylamine (DA). Bench-scale flotation tests showed that a high quality phosphorite concentrate with higher grade and recovery (33.65% and 79.46%, respectively) could be enriched using lower dosage DPA. Economic estimate for a 5000 t/d phosphorite ore concentrator would result in an annual profit increase of approximately $8675330.65 by DPA collector. Density functional theory(DFT) calculations revealed that DPA reacted with Nucleophilic reagent (Phosphorite) by the reactive site of –CH2NH(CH2)2C(NOH)N+H3 group and more easily absorbed on the surface of Phosphorite than DA. Therefore, the above results prove that amidoxime surfactant DPA is an efficient and economic collector to recover high quality phosphate ore, which provides an important guarantee for the production of phosphate fertilizer.

Outcome of Surfactant replacement therapy for respiratory distress syndrome in preterm babies

Introduction: Surfactant is an important treatment modality in preterm babies with respiratory distress syndrome leading to decrease in mortality, morbidity and cost of treatment. Experiences on surfactant therapy in Nepal are scarce. This study was conceptualised to find the use and immediate outcome of surfactant therapy in preterm babies in a tertiary care hospital in Nepal. Methods: A cross-sectional study was done in preterm babies who received surfactant over period of five years at neonatal / pediatric intensive care unit at Patan Hospital, Lalitpur, Nepal. After approval from Institutional review committee, information on gestational age, sex, birth weight, doses of dexamethasone, doses and time surfactant delivery, complications and immediate outcome was retrieved from the files. Comparison between early and late rescue group was done. Data was analysed using SPSS 16. Results: Twelve babies (11.2%) needed a repeat dose of surfactant. Only 12 (11.2%) babies received early rescue surfactant. About 53 (49.5%) babies developed complications with hypotension being the most common seen in 38 (35.5%) babies. Complications were 75% and 46% in the early and late rescue group respectively (p - 0.22). The mortality was inversely proportional to the gestational age (p - 0.002) and birth weight (p &lt; 0.05). Mortality was 16% in both the groups but the deaths related to complications of surfactant was all in the late rescue group. Conclusions: Complications were more in early rescue group and mortality was similar in both the groups, but mortality related to complications of surfactant was all in the late rescue group. Complications of surfactant therapy and mortality were inversely proportional to the gestational age and birth weight.

Preparation of fenpropathrin nanoemulsions for eco-friendly management of Helicoverpa armigera: Improved insecticidal activity and biocompatibility

In this study, the ratio, dosage of surfactants, and emulsification process were selected. The prepared fenpropathrin nanoemulsion exhibited suitable stability and remarkable insecticidal activity against Helicoverpa armigera. The optimal formula in compliance with the standard of FAO was obtained. Fenpropathrin (10 wt%) and ethoxylated castor oil (EL-10: EL-40 = 2: 1, 9 wt%) were dissolved, mixed with hydrocarbon solvent (S-200, 8 wt%) and replenished with deionized water to obtain 100 wt%. The nanoemulsion droplets showed small contact angle and high adhesion work onto corn leaves, indicating that the nanoemulsions exhibited excellent wetting, adhesion and stretching capabilities. Compared with commercial emulsifiable concentrate (EC), the nanoemulsion had lower LC50 (50.01 mg L−1) against the third instar larva of Helicoverpa armigera. This was due to the body of larvae becoming completely darkened, shriveled and incapacitated shortly after treatment. The LC50 of the fenpropathrin nanoemulsion on Eisenia fetida was 96.60 and 47.99 mg kg−1 after 7 and 14 days, respectively. This indicated low toxicity to E. fetida. The L02 cell viability after 24 and 48 h of nanoemulsion treatment was 85.32 % and 68.95 %, respectively. In addition, the fenpropathrin nanoemulsion showed a lower apoptosis rate against L02 cells (8.52 %) than EC (63.18 %) after 24 h, indicating that the nanoemulsion had low cytotoxicity against L02 cells. In general, the utilization and environmental performance of pesticides were improved, with less cytotoxicity. This study will facilitate the preparation and application of nanoemulsions for lipophilic pesticide to enhance insecticidal activity, lower cytotoxicity and improve environmental compatibility.

Evaluation of the Nature and Concentration of the Surfactant on the Properties of Red Mud/Metakaolin Porous Geopolymers Foamed with Aluminium.

The chemical foaming technique is possibly the most common method of producing porous geopolymers. Despite this, to date, the role of the content and type of surfactant on the pore size distribution of porous geopolymers is not fully perceived, as constant surfactant dosages are usually employed. In addition, the comparison of literature studies is challenging since a distinct mixture of designs is employed. This investigation intends to provide additional insights on the topic, focusing on synthesizing red mud/metakaolin geopolymer foams and envisioning their use in thermal insulating applications. Various mixtures were prepared using three commercially available surfactants, namely Hostapur OSB, sodium dodecyl sulfate (SDS), and Triton X114. The content of the surfactant (0.025, 0.05, and 0.075 wt.%) and the amount of the foaming agent (aluminum powder, Al; 0.05, 0.075, and 0.10 wt.%) was modified, keeping the binder composition constant and the physical properties of the produced geopolymers were characterized. Results show that the combination between sodium dodecyl sulfate (0.025 wt.%) and aluminum (0.10 wt.%) leads to the strongest reduction in the foam density, the lowest value here reported being -400 kg/m3. On the other hand, samples produced with Hostapur OSB have much higher open porosity (up to 47.7%) and water absorption (up to 80.4%) values, showing that this surfactant leads to a pore network with higher connectivity. In addition, the microstructure of the foams, particularly pore morphology (size and shape) and connectivity between the produced pores are highly dependent on the type of surfactant, sodium dodecyl sulfate generating coarser pore size distribution with round, but mostly closed pores, while a narrower pore size distribution coupled with smaller size pores is seen with the Hostapur. These results suggest the feasibility of tuning the foams' properties (porosity and mechanical performance) according to the application by the proper combination of the type of surfactant and their concentration, enabling their use as thermal and acoustic insulators or as filters/membranes in wastewater treatment systems.

16 RAM cannula versus Infant Flow Driver systems for post-extubation non-invasive ventilation support in extremely preterm infants - A retrospective cohort study

Abstract Background Non-invasive ventilation (NIV) delivered by RAM cannula is being used for post-extubation support of preterm infants in some centers for its potential benefits of ease of setup and less nasal trauma. Objectives To assess characteristics and clinical outcomes for infants extubated to NIV support delivered via RAM cannula, as compared to those extubated to Vyaire Infant Flow Driver (IFD) systems. Design/Methods Retrospective cohort study. All infants born at 25 to 27 + 6 weeks of gestation during a 3-year period (2016-2018) and admitted to a regional Level-3 NICU, were eligible if: 1) they were ventilated for RDS within 48 hours of birth, and 2) extubated to NIV support using RAM cannula or IFD systems (using Viasys or FabianTM devices). Primary outcome was the failure of the primary mode of NIV support within the first 72 hours post-extubation (defined as need for reintubation or change of initial NIV mode to prevent reintubation). We adjusted for antenatal steroid use and delivery route. Data was stratified for gestational age (GA) &amp;lt;26 wks/&amp;gt;=26 wks. Sensitivity analysis were performed on additional parameters, e.g., inborn status, duration of initial ventilation restricted to &amp;lt;4 days. Logistic and linear regression models were built for the categorical and continuous outcomes. Results 150 infants were enrolled, RAM cannula (n = 62) and IFD devices (n = 88). The majority of patients in both groups were on conventional ventilation, received one dose of surfactant, and were on FiO2 &amp;lt;0.3 prior to extubation. RAM cannula group had significantly longer duration of intubation prior to first extubation (median duration 99 hrs vs 19 hrs). There was no difference in the primary outcome between the groups [(RAM 51.6% and IFD 45.5%; adjOR 1.25(95% CIs: 0.65 – 2.4)]. However, RAM cannula group had higher rates of reintubation within &amp;lt;=7 days after extubation (89.5% vs 68.5%; adjOR 3.87(95% CIs: 1.18, 12.73), p-value=0.026] and higher incidence of IVH [62.9% vs 38.6%; 2.77(95% CIs: 1.39, 5.53), p-value 0.004], with lesser infants weaned to room air prior to discharge [58.1% vs 76.1.6%; adjOR 0.42(95% CIs: 0.21, 0.85), p-value 0.016]. In the stratified analyses by GA, these differences were noted to be restricted to those born at &amp;gt;=26 weeks, with an additional risk for increased BPD36 (adjORs 2.76 (95% CIs: 1.16, 6.57), p-value 0.022] associated with the RAM cannula use in this stratum. Conclusion Post-extubation NIV support via RAM cannula, as compared to IFD systems, was associated with higher rates of reintubation in &amp;lt;=7 days, IVH, with a greater number of infants discharged home on supplemental oxygen.

SURFACTANT THERAPY IN MECONIUM ASPIRATION SYNDROME AND ITS OUTCOME IN TERTIARY CARE HOSPITAL

Aims: To study the role of surfactant therapy in meconium aspiration syndrome and its outcome in tertiary care hospital. Objectives: To evaluate the efcacy of surfactant in the treatment of term and near term infants with meconium aspiration syndrome and their outcome in terms of duration and outcome of ventilation, duration of oxygen requirement,complications associated with meconium aspiration syndrome. Material and methods: 64 neonates admitted in NICU, King George Hospital, Visakhapatnam with symptoms of MAS were enrolled in the study, of them 32 were given surfactant and were taken as cases,32 were not given surfactant and enrolled as controls. Data on APGAR, need for resuscitation, baby weight, gestational age and laboratory prole were recorded. Those babies with downe's score &gt;7 were given high dose(4ml/kg) of surfactant and were followed up. Results: There was a rapid fall in oxygenation index in 24hrs after administration of surfactant and improvement in PaO2/PAO2. In surfactant group mean duration of ventilation, oxygen supplementation after extubation and length of hospital stay were all signicantly low as compared to control groups. Conclusion: Surfactant administration improved PaO2/PAO2 signicantly in comparison to the control group with in 24 hours after delivery, indicating that surfactant aids in improving gaseous exchange at the alveolar capillary barrier in lungs.

Randomized Trial of Surfactant Therapy via Laryngeal Mask Airway Versus Brief Tracheal Intubation in Neonates Born Preterm

To evaluate the possible noninferiority of surfactant administration via laryngeal mask airway (LMA) vs endotracheal tube (ETT) in avoiding the requirement for mechanical ventilation in preterm neonates with respiratory distress syndrome (RDS). This was a randomized controlled trial including infants born at 27 to 36weeks of gestation, >800g, diagnosed with RDS and receiving fraction of inspired oxygen 0.30-0.60 via noninvasive respiratory support. Infants were randomized to surfactant via LMA (with atropine premedication) or ETT (InSuRE approach with atropine and remifentanil premedication). Primary outcome was failure of surfactant treatment to prevent the need for mechanical ventilation. Patients were randomized, 51 to LMA and 42 to the ETT group. Both groups had similar baseline characteristics, with birth weights ranging from 810 to 3560g. Failure rate was 29% in the ETT group and 20% in the LMA group (P=.311). This difference was due to early failures (within 1hour), with 12.5% in the ETT group and 2% in the LMA group (P=.044). Surfactant therapy via LMA was non-inferior to administration via ETT; failure risk difference -9.0% (CI -∞ to 5.7%). Efficacy in decreasing fraction of inspired oxygen, number of surfactant doses administered, time to wean off all respiratory support, rates of adverse events, and outcomes including pneumothorax and BPD diagnosis did not differ between groups. Surfactant therapy via LMA was noninferior to administration via ETT and it decreased early failures, possibly by avoiding adverse effects of premedication, laryngoscopy, and intubation. These characteristics make LMA a desirable conduit for surfactant administration. ClinicalTrials.gov, NCT02164734.

Short-Term Outcome after Repeated Less Invasive Surfactant Administration: A Retrospective Cohort Study

Introduction: Less invasive surfactant administration (LISA) to preterm infants is associated with decreased risk for death or BPD. After LISA, a considerable proportion requires a second dose of surfactant because of ongoing respiratory distress syndrome, raising a clinical dilemma between intubation or performing a repeated LISA (re-LISA) procedure. We aim to assess efficacy of re-LISA in avoiding subsequent nasal continuous positive airway pressure failure (need for intubation in the first 72 h of life; CPAP-F), to identify factors associated with subsequent CPAP-F, and to compare short-term outcomes following re-LISA to surfactant retreatment by endotracheal intubation and mechanical ventilation. Methods: This was an observational retrospective study in two Dutch NICUs. Inclusion criterion was infants with gestational age <32 0/7 weeks requiring a second surfactant dose. Multivariate logistic regression analysis was performed. Results: Of 209 infants requiring second surfactant dose, 132 received re-LISA. Subsequent CPAP-F was observed in 56 (42%) infants and was associated with extreme prematurity (OR 2.6, 95% CI: 1.2–5.8) and FiO₂>0.5 (OR 5.4, 95% CI: 2.0–14.7). Infants receiving re-LISA had a lower risk of death or BPD compared to infants intubated for the second surfactant dose (OR 0.4, 95% CI: 0.2–0.9). Infants with CPAP-F after re-LISA had similar outcomes compared to those intubated for second surfactant dose. Conclusion: Re-LISA is effective in reducing CPAP-F and is associated with lower risk of death or BPD compared to retreatment via an endotracheal tube. Infants failing CPAP after re-LISA have similar outcomes compared to intubated infants. These findings support the use of re-LISA in preterm infants with ongoing RDS.