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Minimally Invasive Surfactant Administration for the Treatment of Neonatal Respiratory Distress Syndrome: A Multicenter Randomized Study in China

Background/Aims: Nasal continuous positive airway pressure (nCPAP) was recommended as the initial respiratory support for spontaneous breathing in infants with very low birth weight and neonatal respiratory distress syndrome (NRDS). Less invasive surfactant administration (LISA) and minimally invasi...

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Autores principales: Han, Tongyan, Liu, Huiqiang, Zhang, Hui, Guo, Ming, Zhang, Xuefeng, Duan, Yang, Sun, Fuqiang, Liu, Xinjian, Zhang, Xiang, Zhang, Mingtao, Liu, Fang, Bao, Lisha, Xiao, Min, Liu, Weili, Jiang, Rui, Zheng, Jun, Tian, Xiuying, Gao, Qi, Zhang, Wanxian, Guo, Wei, Li, Ling, Tong, Xiaomei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7221055/
https://www.ncbi.nlm.nih.gov/pubmed/32457854
http://dx.doi.org/10.3389/fped.2020.00182
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author Han, Tongyan
Liu, Huiqiang
Zhang, Hui
Guo, Ming
Zhang, Xuefeng
Duan, Yang
Sun, Fuqiang
Liu, Xinjian
Zhang, Xiang
Zhang, Mingtao
Liu, Fang
Bao, Lisha
Xiao, Min
Liu, Weili
Jiang, Rui
Zheng, Jun
Tian, Xiuying
Gao, Qi
Zhang, Wanxian
Guo, Wei
Li, Ling
Tong, Xiaomei
author_facet Han, Tongyan
Liu, Huiqiang
Zhang, Hui
Guo, Ming
Zhang, Xuefeng
Duan, Yang
Sun, Fuqiang
Liu, Xinjian
Zhang, Xiang
Zhang, Mingtao
Liu, Fang
Bao, Lisha
Xiao, Min
Liu, Weili
Jiang, Rui
Zheng, Jun
Tian, Xiuying
Gao, Qi
Zhang, Wanxian
Guo, Wei
Li, Ling
Tong, Xiaomei
author_sort Han, Tongyan
collection PubMed
description Background/Aims: Nasal continuous positive airway pressure (nCPAP) was recommended as the initial respiratory support for spontaneous breathing in infants with very low birth weight and neonatal respiratory distress syndrome (NRDS). Less invasive surfactant administration (LISA) and minimally invasive surfactant therapy (MIST) have been reported to reduce the incidence of bronchopulmonary dysplasia (BPD). This study aimed to explore the applicability of minimally invasive surfactant administration (MISA) in China. Materials and Methods: MISA was a randomized controlled study conducted at eight level III neonatal intensive care units (NICUs) in China. Spontaneously breathing infants born at 25+0 to 31+6 weeks' gestation who progressively developed respiratory distress during the first 6 h after birth were randomly assigned to receive MISA or endotracheal intubation surfactant administration (EISA). The primary outcome was the difference in the morbidity of BPD between two groups of infants with MISA and EISA at 36 weeks corrected gestational age. Results: Demographic and clinical characteristics of the 151 infants in the MISA group were similar to the 147 infants in the EISA group. The comparison showed no clear benefits in the MISA group in the incidence of BPD, while infants from the EISA group had higher rates of patent ductus arteriosus (PDA) (60.5 vs. 41.1%, p = 0.001). The duration of surfactant infusion and the total time of surfactant administration in the MISA group were significantly longer than in the EISA group. A slightly increased heart rate was noted 1 h post surfactant administration in the EISA group. In subgroup analysis, the comparison of 51 smaller (<30 weeks) preterm infants, named MISAs (n = 31) and EISAs (n = 20), showed a significant reduction of BPD (29.0 vs. 70.0%, p = 0.004) and PDA (29.0 vs. 65.0%, p = 0.011). In the subgroup analysis of blood gas, arterial oxygen saturation (SaO(2)) value at 1 and 12 h and partial pressure of arterial oxygen (PaO(2)) at 12 h were all higher in the EISA group compared to the MISA group. Conclusion: MISA had no clear benefit on the incidence of BPD, but it was related to a reduction in PDA. It is an appropriate therapy for spontaneous breathing in infants with extremely low birth weight and NRDS.
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spelling pubmed-72210552020-05-25 Minimally Invasive Surfactant Administration for the Treatment of Neonatal Respiratory Distress Syndrome: A Multicenter Randomized Study in China Han, Tongyan Liu, Huiqiang Zhang, Hui Guo, Ming Zhang, Xuefeng Duan, Yang Sun, Fuqiang Liu, Xinjian Zhang, Xiang Zhang, Mingtao Liu, Fang Bao, Lisha Xiao, Min Liu, Weili Jiang, Rui Zheng, Jun Tian, Xiuying Gao, Qi Zhang, Wanxian Guo, Wei Li, Ling Tong, Xiaomei Front Pediatr Pediatrics Background/Aims: Nasal continuous positive airway pressure (nCPAP) was recommended as the initial respiratory support for spontaneous breathing in infants with very low birth weight and neonatal respiratory distress syndrome (NRDS). Less invasive surfactant administration (LISA) and minimally invasive surfactant therapy (MIST) have been reported to reduce the incidence of bronchopulmonary dysplasia (BPD). This study aimed to explore the applicability of minimally invasive surfactant administration (MISA) in China. Materials and Methods: MISA was a randomized controlled study conducted at eight level III neonatal intensive care units (NICUs) in China. Spontaneously breathing infants born at 25+0 to 31+6 weeks' gestation who progressively developed respiratory distress during the first 6 h after birth were randomly assigned to receive MISA or endotracheal intubation surfactant administration (EISA). The primary outcome was the difference in the morbidity of BPD between two groups of infants with MISA and EISA at 36 weeks corrected gestational age. Results: Demographic and clinical characteristics of the 151 infants in the MISA group were similar to the 147 infants in the EISA group. The comparison showed no clear benefits in the MISA group in the incidence of BPD, while infants from the EISA group had higher rates of patent ductus arteriosus (PDA) (60.5 vs. 41.1%, p = 0.001). The duration of surfactant infusion and the total time of surfactant administration in the MISA group were significantly longer than in the EISA group. A slightly increased heart rate was noted 1 h post surfactant administration in the EISA group. In subgroup analysis, the comparison of 51 smaller (<30 weeks) preterm infants, named MISAs (n = 31) and EISAs (n = 20), showed a significant reduction of BPD (29.0 vs. 70.0%, p = 0.004) and PDA (29.0 vs. 65.0%, p = 0.011). In the subgroup analysis of blood gas, arterial oxygen saturation (SaO(2)) value at 1 and 12 h and partial pressure of arterial oxygen (PaO(2)) at 12 h were all higher in the EISA group compared to the MISA group. Conclusion: MISA had no clear benefit on the incidence of BPD, but it was related to a reduction in PDA. It is an appropriate therapy for spontaneous breathing in infants with extremely low birth weight and NRDS. Frontiers Media S.A. 2020-05-07 /pmc/articles/PMC7221055/ /pubmed/32457854 http://dx.doi.org/10.3389/fped.2020.00182 Text en Copyright © 2020 Han, Liu, Zhang, Guo, Zhang, Duan, Sun, Liu, Zhang, Zhang, Liu, Bao, Xiao, Liu, Jiang, Zheng, Tian, Gao, Zhang, Guo, Li and Tong. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Han, Tongyan
Liu, Huiqiang
Zhang, Hui
Guo, Ming
Zhang, Xuefeng
Duan, Yang
Sun, Fuqiang
Liu, Xinjian
Zhang, Xiang
Zhang, Mingtao
Liu, Fang
Bao, Lisha
Xiao, Min
Liu, Weili
Jiang, Rui
Zheng, Jun
Tian, Xiuying
Gao, Qi
Zhang, Wanxian
Guo, Wei
Li, Ling
Tong, Xiaomei
Minimally Invasive Surfactant Administration for the Treatment of Neonatal Respiratory Distress Syndrome: A Multicenter Randomized Study in China
title Minimally Invasive Surfactant Administration for the Treatment of Neonatal Respiratory Distress Syndrome: A Multicenter Randomized Study in China
title_full Minimally Invasive Surfactant Administration for the Treatment of Neonatal Respiratory Distress Syndrome: A Multicenter Randomized Study in China
title_fullStr Minimally Invasive Surfactant Administration for the Treatment of Neonatal Respiratory Distress Syndrome: A Multicenter Randomized Study in China
title_full_unstemmed Minimally Invasive Surfactant Administration for the Treatment of Neonatal Respiratory Distress Syndrome: A Multicenter Randomized Study in China
title_short Minimally Invasive Surfactant Administration for the Treatment of Neonatal Respiratory Distress Syndrome: A Multicenter Randomized Study in China
title_sort minimally invasive surfactant administration for the treatment of neonatal respiratory distress syndrome: a multicenter randomized study in china
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7221055/
https://www.ncbi.nlm.nih.gov/pubmed/32457854
http://dx.doi.org/10.3389/fped.2020.00182
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