Neonatal Fellow National Maternity Hospital, Dublin, Ireland National Maternity Hospital, Holles Street, Dublin Dublin, Ireland
Background: Preterm infants are at high risk of developing respiratory distress syndrome (RDS). Endotracheal surfactant is effective in preventing and treating RDS; however, intubation is invasive and associated with adverse effects. Half of infants born <29 weeks’ gestation initially managed with continuous positive airway pressure (CPAP) are ultimately intubated for surfactant. Administration of surfactant into the pharynx has been reported in preterm animals and humans and may be effective.
Objective: We wished to determine whether giving oropharyngeal surfactant at birth reduces the rate of endotracheal intubation for respiratory failure in preterm infants within 120 hours.
Design/Methods: Infants born before 29 weeks’ gestation who were free of major anomalies were enrolled to this unblinded study at 9 centres in 6 European countries. They were randomly assigned to receive oropharyngeal surfactant at birth in addition to CPAP or CPAP alone. The primary outcome was intubation within 120 hours of birth, either for bradycardia and/or apnoea despite respiratory support in the delivery room, or for pre-specified respiratory failure criteria in the neonatal intensive care unit. Secondary outcomes included incidence of mechanical ventilation, chronic lung disease, and death before hospital discharge.
Results: A total of 251 infants were included in the study; 126 infants were assigned to oropharyngeal surfactant and 125 infants to control. The groups were well matched at study entry (table 1); their mean (SD) gestational age was 26 (2) vs 26 (2) weeks, and their mean (SD) birth weight was 874 (261) vs 851 (253) g respectively. There was no difference between groups in the rate of intubation at 120 hours [79/126 (63) vs 81/125 (65) %, p=0.793] (table 2). There were no differences between the groups in the rate or duration of mechanical ventilation; the rates of bronchopulmonary dysplasia, chronic lung disease, or postnatal steroid use; or in the rate of death before hospital discharge. Conclusion(s): Administration of surfactant into the oropharynx immediately after birth in addition to CPAP compared to CPAP alone did not reduce the rate of intubation amongst infants born before 29 weeks’ gestation in the first 5 days of life.
Authors/Institutions: Madeleine C. Murphy, National Maternity Hospital, Holles Street, Dublin, Dublin, , Ireland; Jan Miletin, Coombe Women and Infants University Hospital, Dublin, , Ireland; Hans Jorgen Guthe, Haukeland Universitetssjukehus, Bergen, , Norway; Claus Klingenberg, University Hospital of North Norway, Tromsø, , Norway; Vincent Rigo, Centre Hospitalier Universitaire de Liège, Belgium, Liege, , Belgium; richard plavka, Charles University, Prague, Czech Republic, Prague, , Czechia; Kajsa Bohlin, Karolinska Institutet, Stockholm, Stockholm, Sweden; Almerinda Periera, Hospital de Braga, Braga, Portugal, Braga, , Portugal; Tomas Juren, University Hospital Brno, Brno, Czech Republic, Brno, , Czechia; Colm P. O'Donnell, National Maternity Hospital, Dublin, , Ireland