Surfactant replacement therapy (SRT) plays a pivotal role in the management of neonates with respiratory distress syndrome (RDS) because it improves survival and reduces respiratory morbidities Pulmonary surfactant is a complex mixture of phospholipids and proteins that creates a cohesive surface layer over the alveoli which reduces surface tension and maintains alveolar stability therefore preventing atelectasis. Surfactant deficiency is a recognized cause of respiratory distress syndrome in the preterm neonate Exogenous surfactant has been shown to reduce neonatal mortality, death or bronchopulmonary dysplasia (BPD) and airleaks 1, 2. The principle of administration is to deliver surfactant as early as possible to those infants with a high probability of surfactant deficiency. Increase RDS risk Decrease RDS risk Decreasing gestational age
To provide guidance on surfactant administration in preterm and term neonates who either present with, or are at high risk of developing, surfactant deficiency respiratory distress syndrome. The document outlines the indications, dosage, formulation and procedure for surfactant administration & timing/strategies for surfactant use Surfactant is indicated for the treatment of RDS in premature infants. Surfactant (Beractant used in trials) administration in ventilated infants with Meconium Aspiration Syndrome (MAS) has been found to improve oxygenation in most studies but there are many non-responders and the effect may be transient Early administration of surfactant to intubated infants with respiratory distress syndrome (RDS) is desirable. Discuss with the PIPER consultant (1300 137 650) when considering surfactant therapy prior to transfer to a Level 6 neonatal unit. Access to x-ray and blood gas facilities is essential when considering the use of surfactant therapy Secondary surfactant deficiency also contributes to acute respiratory morbidity in late-preterm and term neonates with meconium aspiration syndrome, pneumonia/sepsis, and perhaps pulmonary hemorrhage; surfactant replacement may be beneficial for these infants
To determine if preterm infants with moderate respiratory distress syndrome on continuous positive airway pressure (CPAP) who received surfactant via a laryngeal mask airway (LMA) would have a decreased rate of intubation and mechanical ventilation compared with those on CPAP who did not receive surfactant surfactant administration in neonates: A review of delivery methods. can j respir ther 2014;50(3):91-95. Surfactant has revolutionized the treatment of respiratory distress syn-drome and some other respiratory conditions that affect the fragile neona-tal lung. Despite its widespread use, the optimal method of surfactant Surfactant treatment of neonatal respiratory distress syndrome (RDS) was introduced in Europe during the 1990s. Meta-analyses have indicated that using less invasive surfactant administration techniques on preterm neonates receiving continuous positive airway pressure (CPAP) results in improved survival rates without bronchopulmonary dysplasia
The LISA technique, also referred to as minimally invasive surfactant therapy (MIST), is a method for administering surfactant via an endotracheally placed catheter to infants spontaneously. The majority of extremely low gestational age neonates undergo intubation for surfactant therapy. Less invasive surfactant administration (LISA) uses a thin catheter inserted into the trachea to. What the quality statement means for different audiences. Service providers (such as neonatal units, including special care units, local neonatal units and neonatal intensive care units) ensure that processes are in place and healthcare professionals are trained to administer surfactant using a minimally invasive technique to preterm babies who do not need invasive ventilation Surfactant therapy is the medical administration of exogenous surfactant. Surfactants used in this manner are typically instilled directly into the trachea .  When a baby comes out of the womb and the lungs are not developed yet, they require administration of surfactant in order to process oxygen and survive
Surfactant-replacement therapy is, unquestionably, the single most important advance in neonatal medicine of the past 20 years, and it is responsible for the largest decrease in neonatal mortality during that time.1 Since surfactant deficiency was first implicated in neonatal respiratory distress syndrome (RDS), there have been hundreds of clinical trials and thousands of papers defining surfactant biochemistry and physiology . The LISA procedure is to give intratracheal surfactant to a spontaneously breathing. The question of whether and how infants should be sedated for MIST remains uncertain, and future techniques for truly non-invasive surfactant administration may negate the need for sedation entirely. Further research is underway to help guide clinicians in balancing infant comfort and maximising outcomes for preterm infants requiring surfactant
Surfactant CK was an extract of porcine lung and was shown to have beneficial effects on lung function when administered to preterm neonates with RDS in uncontrolled studies in the early 1980s.[72,73] It was never developed commercially. 2.2.2 Animal-Derived Surfactants Extracted from Whole Lung Respiratory distress syndrome (RDS) is caused by pulmonary surfactant deficiency, which typically occurs only in neonates born at < 37 weeks gestation; deficiency is worse with increasing prematurity. With surfactant deficiency, alveoli close or fail to open, and the lungs become diffusely atelectatic, triggering inflammation and pulmonary edema CPAP is the most studied form of noninvasive ventilation in neonates, and early investigations focused on the use of CPAP following surfactant administration, to minimize the need for invasive mechanical ventilation. 1 Verder and colleagues demonstrated that a strategy of CPAP following brief intubation and surfactant administration (the INSURE technique: INtubation, SURfactant, Extubation. Surfactant administered within 30 to 60 minutes of the birth of a premature neonate is found to be beneficial. Surfactant hastens recovery and decreases the risk of pneumothorax, interstitial emphysema, intraventricular hemorrhage (IVH), BPD, and neonatal mortality in the hospital and at one year
Surfactant was the first drug developed solely for treatment of neonates; a major breakthrough in neonatal medicine in the past 35 years. Surfactant reduced both neonatal mortality and pulmonary air leaks by about 50%. Its introduction was also associated with a 6% reduction in infant mortality in the USA SRT in Neonates Exogenous surfactant therapy has an established role in the management of RDS. SRT reduces the incidence of death, air leak syndromes, and intraventricular hemorrhage in premature infants. The optimal patient population and timing of surfactant delivery remains controversial The majority of extremely low gestational age neonates undergo intubation for surfactant therapy. Less invasive surfactant administration (LISA) uses a thin catheter inserted into the trachea to.. Between intubation and surfactant administration, these infants should be ventilated very carefully with low tidal volume and pressures. ≥24 weeks' gestational age: b.1 For infants intubated immediately after birth, it is recommended that surfactant be given as early treatment (<2 h of age), except if the infant is on room air and minimal. Surfactant prophylaxis is traditionally defined as surfactant administration solely on the basis of gestational age and/or expected high risk of RDS. In the modern context of noninvasive..
Surfactant therapy is an effective treatment for RDS in preterm infants The new trial was a French multicenter study: Hascoet JM, et al. Late Surfactant Administration in Very Preterm Neonates With Prolonged Respiratory Distress and Pulmonary Outcome at 1 Year of Age: A Randomized Clinical Trial
Surfactant can be given to preterm babies using a minimally invasive technique if they are not on invasive ventilation. Using a minimally invasive technique reduces the risk of bronchopulmonary dysplasia (BPD) and pneumothorax (collapsed lung) Laryngeal mask airway surfactant administration for prevention of morbidity and mortality in preterm infants with or at risk of respiratory distress syndrome. Cochrane Database Syst Rev 2011; :CD008309
Pulmonary surfactants reduce the risk of death and bronchopulmonary dysplasia (BPD) in preterm infants with respiratory distress syndrome. Lungs of preterm infants are susceptible to injury from mechanical ventilation 1.1 To provide a process for surfactant administration to neonates in neonatal areas. 1.2 Surfactant therapy in premature infants should be given as early rescue therapy and not prophylactically. Early rescue therapy is defined as administration of surfactant between 30 and 120 minutes of birth, after initial stabilization Surfactant replacement has been investigated since 1960s and become one of the standard treatment for very-low-birth-weight preterm infants since early 1990s. 1, 2 In the past, clinical trials have demonstrated that exogenous surfactant supplementation effectively improve clinical outcome by either prophylactic or rescue administration for. Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome Cochrane 2007 Stevens TP, Harrington EW, Blennow M, Soll RF This update includes complete data from three studies published in 2004 or after [Dani 2004, Texas.
Neonatal respiratory distress syndrome due to surfactant deficiency is associated with high morbidity and mortality in preterm infants, and the use of less invasive surfactant administration (LISA. For infants with worsening RDS, early rescue surfactant should be provided. While the strategy to intubate, give surfactant, and extubate (INSURE) has been widely accepted in clinical practice, newer methods of noninvasive surfactant administration, using thin catheter, laryngeal mask airway, or nebulization, are being adopted or investigated 7 Nouraeyan, et al. Surfactant administration in neonates: A review of delivery methods. Can J Respir Ther. 2014 Autumn; 50(3):91-95 8 Lewis, et al. Evaluation of exogenous surfactant treatment strategies in an adult model of acute lung injury. J
Nasopharyngeal surfactant administration was first studied by the Ten Centre Study Group involving 328 infants (159 infants with nasopharyngeal surfactant, 149 infants without surfactant) and reported an average of 20 hours less ventilation among infants receiving the surfactant and a significant reduction in mortality (19% vs 30%, P < .01). 24. No studies of prophylactic or early nebulised surfactant administration were found. A single small study of late rescue nebulised surfactant was included. The study is of moderate risk of bias. The study enrolled 32 preterm infants born < 36 weeks' gestation with RDS on nasal continuous positive airway pressure (nCPAP)
Surfactant treatment of neonatal respiratory distress syndrome (RDS) was introduced in Europe during the 1990s. Meta‐analyses have indicated that using less invasive surfactant administration techniques on preterm neonates receiving continuous positive airway pressure (CPAP) results in improved survival rates without bronchopulmonary dysplasia Rationale: Bronchopulmonary dysplasia (BPD) is an important complication of mechanical ventilation in preterm infants, and no definite therapy can eliminate this complication. Pulmonary inflammation plays a crucial role in its pathogenesis, and glucocorticoid is one potential therapy to prevent BPD. Objectives: To compare the effect of intratracheal administration of surfactant/budesonide with. Surfactant Replacement Therapy for Respiratory Distress Syndrome in Preterm Infants: United Kingdom National Consensus. PubMed, July 2019, pubmed.ncbi.nlm.nih.gov/30780152 . Disclosure: The links to the textbooks are affiliate links which means, at no additional cost to you, we will earn a commission if you click through and make a purchase
CUROSURF ® (poractant alfa) is intended for intratracheal use only. The administration of exogenous surfactants, including CUROSURF, can rapidly affect oxygenation and lung compliance. Therefore, infants receiving CUROSURF should receive frequent clinical and laboratory assessments so that oxygen and ventilatory support can be modified to respond to respiratory changes There were no serious adverse events associated with placement of the LMA or surfactant administration. Conclusions: In premature neonates with moderate respiratory distress syndrome, surfactant administered through an LMA decreased the rate of intubation and mechanical ventilation
Surfactant administration in preterm infants with NRDS reduces morbidity and mortality. There is a reduced risk of air leak and chronic lung disease. In NRDS, the earlier surfactant is used, the better the outcomes. Also, the outcome is reportedly better, if early surfactant administration is followed by extubation of preterm infants with RDS. Premature infants are subjected to adverse effects of intubation to benefit from surfactant. We hypothesized that administration of surfactant through a laryngeal mask airway (LMA) is as effective as administration through an endotracheal tube (ETT) and that time and physiologic changes during instrumentation will be less in the LMA group Specific recommendations on surfactant administration in late preterm (LPT) infants with pulmonary disease are lacking. We performed an online-based, nationwide survey amongst all (n = 102) Belgian neonatologists to identify the use of surfactant in LPT infants suffering from several respiratory pathologies. The survey used clearly defined clinical cases and resulted in a 86% response rate
Surfactant Administration in Preterm Infants (surfactant) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government In addition, surfactant administration by LMA can be considered in more mature infants (32-36 weeks gestation) at the higher oxygen threshold of 30-35% FiO2. One of the advantages of this technique is that it is a relatively simple procedure to perform compared with other routes of surfactant administration Intratracheal administration of synthetic surfactant to infants with established respiratory distress syndrome has been demonstrated to improve clinical outcome. Infants who are treated with synthetic surfactant have a decreased risk of pneumothorax, a decreased risk of pulmonary interstitial emphysema, a decreased risk of intraventricular. Less Invasive Surfactant Administration Therapy (LISA) Neonatal Clinical Guideline V2.0 Page 3 of 11 1. Aim/Purpose of this Guideline 1.1. This guideline aims to provide guidance for treating babies admitted to the neonatal unit where surfactant deficiency is suspected and mechanical ventilation is not an absolute indication 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 respiratory distress syndrome. Cochrane Database Syst Rev. 2004. CD003063. Procedure for the administration of surfactants: Place the infant in supine position and give the surfactant as quickly as tolerated so that the total dose is usually given over 3 - 5 minutes. There is no evidence to support the practice of placing the infant in multiple positions during administration