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Secondary surfactant administration in neonates with respiratory decompensation

Journal of Perinatology volume 28, pages 192–198 (2008)Cite this article

Abstract

Objective:

To evaluate blood gases and ventilatory parameters before and after two doses of surfactant in premature infants with respiratory decompensation after recovery from primary respiratory distress syndrome (RDS).

Study Design:

This prospective pilot study enrolled infant's ⩾500 g birth weight, from 7 days to 3 months of age, with a secondary respiratory decompensation lasting at least 4 h prior to study entry. Infants received two doses of surfactant, 12 h apart.

Result:

A total of 20 neonates qualified for secondary surfactant administration. PCO2 (P<0.001); pH (P<0.001); mean airway pressure (P<0.05); FiO2 (P<0.05); modified ventilatory indices (P<0.004) and respiratory severity scores (P<0.001) improved significantly at both 12 and 24 h after surfactant administration.

Conclusion:

Secondary surfactant administration may be effective in reducing short-term ventilatory requirements in neonates who have a respiratory decompensation after recovery from initial RDS. Randomized controlled trials are needed to confirm these preliminary findings.

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References

  1. Hamilton B, Ventura S, Martin J, Sutton P . Preliminary births for 2004 National Center for Health Statistics. Health E-Stats 2004 [cited 2006]; Available on http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelim_births/prelim_births04.htm.

  2. Jobe A, Bancalarie E . Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163: 1723–1729.

    Article  CAS  PubMed  Google Scholar 

  3. Merrill J, Ballard R, Cnann A, Hibbs A, Godinez R, Godinez M et al. Dysfunction of pulmonary surfactant in chronically ventilated premature infants. Pediatr Res 2004; 56 (6): 918–926.

    Article  CAS  PubMed  Google Scholar 

  4. Kaneko M, Watanabe J, Ueno E . Surfactant lavage and replacement in meconium aspiration syndrome with pulmonary hemorrhage. J Perinat Med 2001; 29: 351–356.

    Article  CAS  PubMed  Google Scholar 

  5. Harms K, Herting E . Successful surfactant replacement therapy in two infants with ARDS due to chlamydial pneumonia. Respiration 1994; 61: 348–352.

    Article  CAS  PubMed  Google Scholar 

  6. Pandit P, Dunn M, Colucci E . Surfactant therapy in neonates with respiratory deterioration due to pulmonary hemorrhage. Pediatrics 1995; 95 (1): 32–36.

    CAS  PubMed  Google Scholar 

  7. Amizuka T, Shimizu H, Niida Y, Ogawa Y . Surfactant therapy in neonates with respiratory failure due to haemorrhagic pulmonary oedema. Eur J Pediatr 2003; 162: 697–702.

    Article  CAS  PubMed  Google Scholar 

  8. Pandit P, O’Brien K, Asztalos E, Colucci E, Dunn M . Outcome following pulmonary haemorrhage in very low birthweight neonates treated with surfactant. Arch Dis Child Fetal Neonatal Ed 1999; 81: 40–44.

    Article  Google Scholar 

  9. Dargaville P, Mills J, Soll R . Therapeutic lung lavage for meconium aspiration syndrome in newborn infants. Cochrane Database Syst Rev 2002; 4: 1–5.

    Google Scholar 

  10. Herting E, Moller O, Schiffmann J, Robertson B . Surfactant improves oxygenation in infants and children with pneumonia and acute respiratory distress syndrome. Acta Paediatr 2002; 91: 1174–1178.

    Article  CAS  PubMed  Google Scholar 

  11. Wiswell TE, Knight G, Finer N, Donn S, Desai H, Walsh W et al. A multicentered, randomized, controlled trial comparing Surfaxin (Lucinactant) lavage with standard care for treatment of meconium aspiration syndrome. Pediatrics 2002; 109: 1081–1087.

    Article  PubMed  Google Scholar 

  12. Herting E, Gefeller O, Land M, van Sonderen L, Harms K, Robertson B, Members of the Collaborative European Multicenter Study Group. Surfactant treatment of neonates with respiratory failure and group B streptococcal infection. Pediatrics 2000; 106 (5): 957–965.

    Article  CAS  PubMed  Google Scholar 

  13. Tibby S, Hatherill M, Wright S, Wilson P, Postle A, Murdoch L . Exogenous surfactant supplementation in infants with respiratory syncytial virus bronchiolitis. Am J Respir Crit Care Med 2000; 162 (4): 1251–1256.

    Article  CAS  PubMed  Google Scholar 

  14. Pandit PB, Dunn MS, Kelly EN, Perlman M . Surfactant replacement in neonates with early chronic lung disease. Pediatrics 1995; 95: 851–854.

    CAS  PubMed  Google Scholar 

  15. Merrill J, Ballard P, Hibbs A, Godinez R, Godinez M, Luan X et al. Booster surfactant therapy beyond the first week of life in ventilated extremely low gestation age infants. Pediatr Res 2004; 56: 918–926.

    Article  CAS  PubMed  Google Scholar 

  16. Katz L, Klein J . Repeat surfactant therapy for postsurfactant slump. J Perinatol 2006; 26: 414–422.

    Article  CAS  PubMed  Google Scholar 

  17. Bissinger R, Carlson C, Hulsey T, Eicher D . Secondary surfactant deficiency in neonates. J Perinatol 2004; 24: 663–666.

    Article  PubMed  Google Scholar 

  18. Notter RH, Egan EA, Kwong MS, Holm BA, Shapire DL . Lung surfactant replacement in premature lambs with extracted lipids from bovine lung lavage: effects of dose, dispersion technique and gestational age. Pediatr Res 1985; 19: 569–577.

    Article  CAS  PubMed  Google Scholar 

  19. Ilce Z, Guney C, Eray N, Ilikkan B, Celayir S . The role of modified ventilatory index in defining the prognosis in surgical and non-surgical pediatric patients. Internet J Pulm Med 2005; 5 (1): 1–8.

    Google Scholar 

  20. Rivera R, Butt W, Shann F . Predictors of mortality in children with respiratory failure: Possible indications for ECMO. Anaesth Int 1990; 18: 385–389.

    CAS  Google Scholar 

  21. Azarow K, Messineo A, Pearl R, Filler R, Barker G, Bohn D . Congenital diaphragmatic hernia—a tale of two cities: the Toronto experience. J Pediatr Surg 1997; 32 (3): 395–400.

    Article  CAS  PubMed  Google Scholar 

  22. Sakura Y, Azarow K, Cutz E, Messineo A, Pearl R, Bohn D . Pulmonary barotrauma in congenital diaphragmatic hernia: a clinicopathological correlation. J Pediatr Surg 1999; 34 (12): 1813–1817.

    Article  Google Scholar 

  23. Keshen T, Gursoy M, Shew S, Smith E, Miller R, Wearden M et al. Does extracorporeal membrane oxygenation benefit neonates with congenital diaphragmatic hernia? Application of a predictive equation. J Pediatr Surg 1997; 32 (6): 818–822.

    Article  CAS  PubMed  Google Scholar 

  24. Lewis J, Veldhuizen R . Factors influencing efficacy of exogenous surfactant in acute lung injury. Biol Neonate 1995; 67 (Suppl 1): 48–60.

    Article  CAS  PubMed  Google Scholar 

  25. Enhorning G, Shennan A, Possmayer F, Dunn M, Chen C, Milligan J . Prevention of neonatal respiratory distress syndrome by tracheal administration of surfactant: a randomized clinical trial. Pediatrics 1985; 76: 145–153.

    CAS  PubMed  Google Scholar 

  26. Wilson D, Zaritsky A, Bauman LA, Dockery K, James RL, Conrad D et al. Instillation of calf lung surfactant extract (calfactant) is beneficial in pediatric acute hypoxemic respiratory failure. Crit Care Med 1999; 27 (1): 188–195.

    Article  Google Scholar 

  27. Mulrooney N, Jobe A, Ikegami M . Lung inflammatory responses to intratracheal interleukin-1alpha in ventilated preterm lambs. Pediatr Res 2004; 55 (4): 682–687.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank the Neonatal Nurse Practitioner Team and the Respiratory Therapists at MUSC for their support and assistance during this study. We especially thank three NNPs, Mary Kay Colliton, Ashley Klumb and Margaret Conway-Orgel, who participated on the research team and our research nurse, Deanna Fanning. This study was partly funded by ROSS Pharmaceuticals and Dey Laboratories. ROSS Pharmaceuticals provided Survanta for study patients at no cost. Dey Laboratories provided an educational grant to cover the cost of the Curosurf. No other funding was provided for this study and none of these companies had involvement in the research or access to the outcome.

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Authors and Affiliations

  1. Department of Nursing, Medical University of South Carolina, Charleston, SC, USA

    R Bissinger, C Carlson, Y Michel, C Dooley, T Hulsey & D Jenkins

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  1. R Bissinger
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Correspondence to R Bissinger.

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Bissinger, R., Carlson, C., Michel, Y. et al. Secondary surfactant administration in neonates with respiratory decompensation. J Perinatol 28, 192–198 (2008). https://doi.org/10.1038/sj.jp.7211909

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