Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Technique for Intrapartum Administration of Surfactant without Requirement for an Endotracheal Tube

Abstract

OBJECTIVE: To evaluate the feasibility and safety of administering surfactant into the nasopharynx during delivery, thus permitting the baby to aspirate the solution into the fluid-filled airway as an air–fluid interface is established. This process avoids the endotracheal intubation (ETI) and positive pressure ventilation (PPV) usually associated with prophylaxis, thus avoiding the pulmonary barotrauma associated with the conventional method of surfactant administration.

STUDY DESIGN: In all, 23 neonates weighing 560 to 1804 g and born at 27 to 30 weeks had their nasopharyngeal airways suctioned and then 3.0–4.5 ml Infasurf® instilled into the nasopharynx before delivery of the shoulders. Continuous positive airway pressure (CPAP) of 10 cmH2O was administered by mask as the babies initiated breathing. Nasal CPAP at 6 cmH2O was then continued for a minimum of 48 hours.

RESULTS: In all, 13 of 15 babies delivered vaginally were weaned quickly to room air and required no further surfactant or endotracheal intubation for RDS. Five of eight babies delivered by C-section required subsequent endotracheal intubation soon after birth and two received subsequent endotracheal tube surfactant.

CONCLUSION: Nasopharyngeal surfactant instillation at birth appears to be relatively safe and simple to accomplish, especially for vaginal births. A large randomized clinical trial will be required to determine the efficacy of this technique when compared to prophylaxis by endotracheal intubation and to nCPAP alone.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Avery ME, Mead J . Surface properties in relation to atelectasis and hyaline membrane disease. Am J Dis Child 1959;97:517–523.

    CAS  Google Scholar 

  2. Malloy M, Freeman DH . Respiratory distress syndrome mortality in the United States. J Perinatol 2000;20:414–420.

    Article  CAS  Google Scholar 

  3. Bancalari E, delMoral T . Bronchopulmonary dysplasia and surfactant. Biol Neonate 2001;80(Suppl 1):7–13.

    Article  CAS  Google Scholar 

  4. Jobe A, Ikegami M . Lung development and function in preterm infants in the surfactant treatment era. Annu Rev Physiol 2000;62:825–846.

    Article  CAS  Google Scholar 

  5. Bjorklund LJ, Ingimarsson J, Curstedt T, et al. Manual ventilation with a few large breaths at birth compromises the therapeutic effect of subsequent surfactant replacement in immature lambs. Pediatr Res 1997;42:348–355.

    Article  CAS  Google Scholar 

  6. Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK . Treatment of the idiopathic respiratory distress syndrome with continuous positive airway pressure. N Engl J Med 1971;284:1333–1340.

    Article  CAS  Google Scholar 

  7. Kattwinkel J, Fleming D, Cha C, Fanaroff AA, Klaus MH . A new device for the administration of continuous positive airway pressure by the nasal route. Pediatrics 1973;52:131–134.

    CAS  Google Scholar 

  8. VanMarter LJ, Allerd EN, Pagano M, et al. The Neonatology Committee for the Developmental Epidemiology Network. Do clinical markers of barotrauma and oxygen toxicity explain interhospital variation in rates of chronic lung disease? The Neonatology Committee for the Developmental Network. Pediatrics 2000;105:1194–1201.

    Article  CAS  Google Scholar 

  9. Aly HZ . Nasal prongs continuous positive airway pressure: a simple yet powerful tool. Pediatrics 2001;108:759–761.

    Article  CAS  Google Scholar 

  10. DeKlerk AM, DeKlerk RK . Use of continuous positive airway pressure in preterm infants: comments and experience from New Zealand. Pediatrics 2001;108:761–762.

    Article  CAS  Google Scholar 

  11. Niermeyer S, Kattwinkel J, VanReempts P, et al. Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care, Part-11 Neonatal Resuscitation. Circulation 2000;102(8, Suppl I):343–347 and Pediatrics 2000;106:e29.

    Google Scholar 

  12. Karlberg P, Cherry RB, Escardo FB, Koch G . Respiratory studies in newborn infants II: pulmonary ventilation and mechanics of breathing in the first minutes of life, including the onset of respiration. Acta Paediatr 1962;51:121–136.

    Google Scholar 

  13. Ikegami M, Kallapur S, Michna J, Jobe AH . Lung injury and surfactant metabolism after hyperventilation of premature lambs. Pediatr Res 2000;47:398–404.

    Article  CAS  Google Scholar 

  14. Berry D, Jobe A, Ikegami M . Leakage of macromolecules in ventilated and unventilated segments of preterm lamb lungs. J Appl Physiol 1991;70:423–429.

    Article  CAS  Google Scholar 

  15. Robertson B, Berry D, Curstedt T, et al. Leakage of protein in the immature rabbit lung; effect of surfactant replacement. Respir Physiol 1985;61:265–276.

    Article  CAS  Google Scholar 

  16. Enhorning G, Robertson B . Lung expansion in the premature rabbit fetus after tracheal deposition of surfactant. Pediatrics 1972;50:58–66.

    CAS  PubMed  Google Scholar 

  17. Enhorning G, Grossman G, Robertson B . Pharyngeal deposition of surfactant in the premature rabbit fetus. Biol Neonate 1973;22:126–132.

    Article  CAS  Google Scholar 

  18. Michna J, Jobe AH, Ikegami M . Positive end-expiratory pressure preserves surfactant function in preterm lambs. Am J Respir Crit Care Med 1999;160:634–639.

    Article  CAS  Google Scholar 

  19. Morley CJ, editor. Ten centre trial of artificial surfactant (artificial lung expanding compound) in very premature babies. BMJ 1987;294:991–996.

    Article  Google Scholar 

  20. Henry MD, Rebello CM, Ikegami M, Jobe AH, Langenback EG, Davis JM . Ultrasonic nebulized in comparison with instilled surfactant treatment in preterm lambs. Am J Respir Crit Care Med 1996;154:366–375.

    Article  CAS  Google Scholar 

  21. Jobe A, Ikegami M, Jacobs H, Jones S . Surfactant and pulmonary blood flow distribution following treatment of preterm lambs with natural surfactant. Clin Invest 1984;73:848–856.

    Article  CAS  Google Scholar 

  22. Cummings JJ, Holm BA, Nickerson PA, Ferguson WH, Egan EA . Pre- versus post-ventilatory surfactant treatment in surfactant-deficient preterm lambs. Reprod Fertil Dev 1995;7:1333–1338.

    Article  CAS  Google Scholar 

  23. Kendig JW, Ryan RM, Sinkin RA, et al. Comparison of two strategies for surfactant prophylaxis in very premature infants: a multicenter randomized trial. Pediatrics 1998;101:1006–1012.

    Article  CAS  Google Scholar 

  24. Verder H, Robertson B, Greisen G, et al. Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. Danish–Swedish Multicenter Study Group. N Engl J Med 1994;331(16):1051–1055.

    Article  CAS  Google Scholar 

  25. Stevens TP, Blennow M, Soll RF . Early surfactant administration with brief ventilation vs selective surfactant and continued mechanical ventilation for preterm infants with or at risk for RDS. Cochrane Database Syst Rev 2002(2):CD003063.

  26. Morley CJ . Systematic review of prophylactic vs rescue surfactant. Arch Dis Child Fetal Neonatal Ed 1997;77(1):70F–74.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kattwinkel, J., Robinson, M., Bloom, B. et al. Technique for Intrapartum Administration of Surfactant without Requirement for an Endotracheal Tube. J Perinatol 24, 360–365 (2004). https://doi.org/10.1038/sj.jp.7211103

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211103

This article is cited by

Search

Quick links