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[Lung function in premature infants can be improved. Surfactant therapy and CPAP reduce the need of respiratory
M Blennow1, B Jonsson, A Dahlström
1Enheten för pediatrik, barnkliniken, Huddinge sjukhus.
Insights
Exogenous surfactant therapy via the INSURE method (Intubation-SURfactant-Extubation) successfully treated respiratory distress syndrome in very low birthweight infants. This approach significantly improved oxygenation, reducing the need for mechanical ventilation.
Area of Science:
- Neonatal medicine
- Pediatric respiratory care
- Pulmonology
Background:
- Exogenous surfactant therapy is a standard treatment for respiratory distress syndrome (RDS) in very low birthweight (VLBW) infants, typically administered during mechanical ventilation.
- The INSURE (Intubation-SURfactant-Extubation) approach offers an alternative method for surfactant administration.
Observation:
- A study in Stockholm involved 12 VLBW infants (27-30 weeks gestational age) with RDS who were treated with the INSURE approach.
- This method involves brief intubation for surfactant delivery, followed immediately by extubation and continuous positive airway pressure (CPAP).
Findings:
- The INSURE treatment was successful in all 12 infants, demonstrating a significant increase in the a/A ratio (a measure of oxygenation) from 0.17 to 0.46 (P < 0.001).
- Only one infant required subsequent mechanical ventilation for RDS, indicating high treatment efficacy.
Implications:
- The INSURE approach is a highly effective method for treating RDS in VLBW infants, potentially reducing the need for prolonged mechanical ventilation.
- This technique offers a promising alternative for surfactant delivery, improving respiratory outcomes in premature neonates.
Abstract:
Randomised trials have shown exogenous surfactant therapy to reduce mortality and morbidity among very low birthweight (VLBW) infants with respiratory distress syndrome (RDS). Surfactant therapy is normally given to infants on mechanical ventilation. In the Stockholm area, 12 VLBW infants born after 27-30 gestational weeks and suffering from RDS were recently treated using the INSURE (Intubation-SURfactant-Extubation) approach--i.e., surfactant therapy during brief intubation, immediately followed by extubation and continuous positive airway pressure (CPAP) treatment. The treatment was successful in all 12 cases, the mean (+/- SD) a/A ratio increasing significantly from 0.17 +/- 0.04 before the INSURE procedure to 0.46 (0.12 after (P < 0.001). Only one infant later needed mechanical ventilation for RDS.