Surfactant administration via thin catheter during spontaneous breathing: randomized controlled trial

Area of Science:

• Neonatology
• Pediatric Respiratory Medicine
• Critical Care

Background:

• Respiratory distress syndrome (RDS) is a significant concern in preterm infants.
• Current surfactant administration methods, like InSurE (Intubate, Surfactant, Extubate), involve intubation and mechanical ventilation (MV).
• Early surfactant administration during spontaneous breathing is an alternative approach being investigated.

Purpose of the Study:

• To assess the feasibility of the Take Care technique for early surfactant administration.
• To compare the requirement for early mechanical ventilation (MV) between the Take Care and InSurE procedures.
• To evaluate the impact of Take Care on MV duration and bronchopulmonary dysplasia (BPD) rates.

Main Methods:

• A randomized study involving preterm infants (<32 weeks) stabilized with nasal continuous positive airway pressure (nCPAP).
• Infants were randomized to receive early surfactant via the Take Care technique (catheter during spontaneous breathing) or the InSurE procedure.
• Data on MV requirement, duration, and BPD rates were collected and analyzed.

Main Results:

• The Take Care group showed a significantly lower requirement for MV in the first 72 hours (30% vs. 45%).
• Mean durations of nCPAP and MV were significantly shorter in the Take Care group.
• The rate of bronchopulmonary dysplasia was significantly lower in infants treated with the Take Care technique.

Conclusions:

• The Take Care technique is a feasible method for treating RDS in very low birth weight infants.
• This technique significantly reduces the need for and duration of MV.
• The Take Care method leads to a lower incidence of bronchopulmonary dysplasia in preterm infants.