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Early administration of surfactant in spontaneous breathing with nCPAP through a thin endotracheal catheter—An option in the treatment of RDS in ELBW infants?

Journal of Perinatology volume 29, page 256 (2009)Cite this article

With great interest we read the article ‘Surfactants: past, present and future’ by HL Halliday.1 This article describes very well the unique success story of this wonderful substance that has not yet been finished. We were surprised to read about ‘surfactant administration in spontaneously breathing infants using a fine gastric tube’ as a single report at a meeting. In our German literature, this method has been more extensively reported. At our center, we developed and introduced this method for the first time. This method combines the positive effects of nCPAP and surfactant. The underlying idea is that inspiring surfactant is more physiologically appropriate than receiving it by positive pressure inflations as with the INSURE procedure. We reported the results in 2003 at the annual meeting of the GNPI (Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin—Society for Neonatology and Pediatric Intensive Care) in Cologne.2 This method was a topic of discussion at the annual meetings of the GNPI in the following years too.3, 4, 5, 6, 7 Therefore, we performed a pilot study in infants with a gestational age below 27 0/7 weeks. In this study, we showed the feasibility and an improvement of outcomes of the study group compared with a historical control group.8 The need for mechanical ventilation because of RDS was reduced from 77% in the historical control group to 48% in the study group. Mortality decreased from 35 to 12% and the rate of severe IVH in survivors from 32 to 5%. These results, combined with subsequent experiences, were published this year.9 The data confirmed the results of the original feasibility study. Our ongoing randomized controlled trials utilizing this technique are registered (AMV trial ISRCTN 05025922, NINSAPP trial ISRCTN 64011614), but the results are not yet available.

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References

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  1. Department of Neonatology, Childrens' Hospital University of Cologne, Children's Hospital, Cologne, Germany. E-mail: angela.kribs@uk-koeln.de,

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Kribs, A. Early administration of surfactant in spontaneous breathing with nCPAP through a thin endotracheal catheter—An option in the treatment of RDS in ELBW infants?. J Perinatol 29, 256 (2009). https://doi.org/10.1038/jp.2008.245

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