Minimally-invasive surfactant therapy in preterm infants on continuous positive airway pressure
- Peter A Dargaville1,2,
- Ajit Aiyappan1,3,
- Antonio G De Paoli1,
- Carl A Kuschel3,4,5,
- C Omar F Kamlin3,4,5,
- John B Carlin6,7,
- Peter G Davis3,4,5
- 1Department of Paediatrics, Royal Hobart Hospital and University of Tasmania, Hobart, Australia
- 2 Menzies Research Institute, Hobart, Australia
- 3 Neonatal Services, Royal Women's Hospital, Melbourne, Australia
- 4 Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
- 5 Murdoch Childrens Research Institute, Melbourne, Australia
- 6 Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Australia
- 7 Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Correspondence to A/Prof Peter Dargaville, Department of Paediatrics, Royal Hobart Hospital, Liverpool Street, Hobart TAS 7000, Australia;
Contributors A/Professor Peter Dargaville conceived and initiated the study. Drs Dargaville, De Paoli and Aiyappan conducted the feasibility study at RHH, and Drs Kuschel, Kamlin and Davis conducted the feasibility study at RWH. Professor Carlin was the study statistician. A/Professor Dargaville wrote the first draft of the manuscript, which was then edited and finally approved by all authors.
- Received 24 November 2011
- Accepted 21 April 2012
- Published Online First 9 June 2012
Objective To evaluate the applicability and potential effectiveness of a technique of minimally-invasive surfactant therapy (MIST) in preterm infants on continuous positive airway pressure (CPAP).
Methods An open feasibility study of MIST was conducted at two sites. Infants were eligible for MIST if needing CPAP pressure ≥7 cm H2O and FiO2 ≥0.3 (25–28 weeks gestation, n=38) or ≥0.35 (29–32 weeks, n=23). Without premedication, a narrow-bore catheter was inserted through the vocal cords under direct vision. Surfactant (100 or 200 mg/kg Curosurf) was then instilled, followed by reinstitution of CPAP. Outcomes were compared between surfactant-treated infants and historical controls achieving the same CPAP and FiO2 thresholds.
Results Surfactant was successfully administered via MIST in all cases, with a rapid and sustained reduction in FiO2 thereafter. For infants at 25–28 weeks gestation, need for intubation <72 h was diminished after MIST compared with controls (32% vs 68%; OR 0.21, 95% CI 0.083 to 0.55), with a similar trend at 29–32 weeks (22% vs 45%; OR 0.34, 95% CI 0.11 to 1.1). Duration of ventilation and incidence of bronchopulmonary dysplasia were similar, but infants receiving MIST had a shorter duration of oxygen therapy.
Conclusion Surfactant delivery via a narrow-bore tracheal catheter is feasible and potentially effective, and deserves further investigation in clinical trials.
Funding Supported by Clinical Grants 11-382 and 12-028 from the Royal Hobart Hospital Research Foundation, and Program Grant 1005345 from the National Health and Medical Research Council, Australia. The funding sources had no role in the study design, data collection, data analysis, preparation of the report or decision to submit the manuscript.
Competing interests None.
Ethics approval University of Tasmania Human Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data from this manuscript will be made available for authorised and approved research activities.