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01-08-2018 | Original Article

Treatment and outcome data of very low birth weight infants treated with less invasive surfactant administration in comparison to intubation and mechanical ventilation in the clinical setting of a cross-sectional observational multicenter study

Authors: Kristina Langhammer, Bernhard Roth, Angela Kribs, Wolfgang Göpel, Ludwig Kuntz, Felix Miedaner

Published in: European Journal of Pediatrics | Issue 8/2018

Abstract

The aim of this study was to contribute further to existing randomized controlled trials and meta-analyses showing advantages in the outcome of less invasive surfactant administration (LISA)-treated infants and add new aspects concerning treatment and outcome data collected in the routine clinical setting. Four hundred seven very low birth weight infants who received surfactant via either LISA or intubation methods were enrolled in the observational cross-sectional multicenter study. To compare infants in terms of surfactant administration, we used an exact matching procedure (the same gestational age, severe perinatal depression (pH < 7.10), birth weight < 10th percentile, antenatal steroid treatment, and the same gender). To check for robustness, we performed repeated matching. LISA-treated infants required significantly less mechanical ventilation during hospital stay (p < 0.001) and days with supplemental oxygen (p = 0.03). Analgesics and sedatives were used less often during the stay (p < 0.001). Infants treated with LISA had significantly lower rates of bronchopulmonary dysplasia (p = 0.003). LISA failure infants were identified as more likely to be small for gestational age and more immature.

Conclusion: Our study complements former results with advantages for LISA-treated infants in mechanical ventilation and bronchopulmonary dysplasia in the clinical routine.

Trial registration: DRKS00004589

What is Known: • According to existing literature, LISA-treated infants seem to have some favors in terms of treatment and outcome data. Observational studies in routine clinical setting are missing.
What is New: • Data of 407 VLBW infants collected in routine clinical setting showed that LISA-treated infants needed less mechanical ventilation and fewer days with supplemental oxygen and less analgesics and sedatives. A reduced risk of BPD could be showed. SGA infants seem to have higher risks of LISA failure.

Aldana-Aguirre JC, Pinto M, Featherstone RM, Kumar M (2017) Less invasive surfactant administration versus intubation for surfactant delivery in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 102(1):F17–F23CrossRefPubMed

Allegaert K, Veyckemans F, Tibboel D (2009) Clinical practice: analgesia in neonates. Eur J Pediatr 168:765–770CrossRefPubMed

Anadkat JS, Kuzniewicz MW, Chaudhari BP, Cole FS, Hamvas A (2012) Increased risk for respiratory distress among white, male, late preterm and term infants. J Perinatol 32:780–785. https://doi.org/10.1038/jp.2011.191 CrossRefPubMedPubMedCentral

Anand KJ, Hall RW, Desai N, NEOPAIN Trial Investigators Group et al (2004) Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomised trial. Lancet 363(9422):1673–1682CrossRefPubMed

Bartels DB, Schwab F, Geffers C, Poets CF, Gastmeier P (2007) Nosocomial infection in small for gestational age newborns with birth weight <1500 g: a multicentre analysis. Arch Dis Child Fetal Neonatal Ed 92(6):F449–F453CrossRefPubMedPubMedCentral

Beeby PJ, Elliott EJ, Henderson-Smart DJ, Rieger ID (1994) Predictive value of umbilical artery pH in preterm infants. Arch Dis Child 71(2):F93–F96CrossRefPubMed

Carlo WA, McDonald SA, Fanaroff AA, Vohr BR, Stoll BJ, Ehrenkranz RA, Andrews WW, Wallace D, Das A, Bell EF, Walsh MC, Laptook AR, Shankaran S, Poindexter BB, Hale EC, Newman NS, Davis AS, Schibler K, Kennedy KA, Sánchez PJ, van Meurs K, Goldberg RN, Watterberg KL, Faix RG, Frantz ID 3rd, Higgins RD, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (2011) Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks’ gestation. JAMA 306:2348–2358. https://doi.org/10.1001/jama.2011.1752 CrossRefPubMedPubMedCentral

Dargaville P (2015) CPAP, surfactant or both for the preterm infant: resolving the dilemma. JAMA Pediatr 169(8):715–717. https://doi.org/10.1001/jamapediatrics.2015.0909 CrossRefPubMed

Dargaville PA, Aiyappan A, Cornelius A, Williams C, De Paoli AG (2011) Preliminary evaluation of a new technique of minimally invasive surfactant therapy. Arch Dis Child Fetal Neonatal Ed 96:F243–F248. https://doi.org/10.1136/adc.2010.192518 CrossRefPubMed

10.

Dargaville PA, Aiyappan A, De Paoli AG, Kuschel CA, Kamlin CO, Carlin JB, Davis PG (2013) Minimally-invasive surfactant therapy in preterm infants on continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed 98(2):F122–F126. https://doi.org/10.1136/archdischild-2011-301314 CrossRefPubMed

11.

Durrmeyer X, Daoud P, Decobert F, Boileau P, Renolleau S, Zana-Taieb E, Saizou C, Lapillonne A, Granier M, Durand P, Lenclen R, Coursol A, Nicloux M, de Saint Blanquat L, Shankland R, Boëlle PY, Carbajal R (2013) Premedication for neonatal endotracheal intubation: results from the epidemiology of procedural pain in neonates study. Pediatr Crit Care Med 14(4):e169–e175. https://doi.org/10.1097/PCC.0b013e3182720616 CrossRefPubMed

12.

Fuchs H (2015) German experience in the management of ELGAN infants. Acta Biomed 86(Suppl 1):16–20PubMed

13.

Göpel W, Kribs A, Ziegler A, Laux R, Hoehn T, Wieg C, Siegel J, Avenarius S, von der Wense A, Vochem M, Groneck P, Weller U, Möller J, Härtel C, Haller S, Roth B, Herting E (2011) Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. Lancet 378(9803):1627–1634CrossRefPubMed

14.

Göpel W, Kribs A, Härtel C, Avenarius S, Teig N, Groneck P, Olbertz D, Roll C, Vochem M, Weller U, von der Wense A, Wieg C, Wintgens J, Preuss M, Ziegler A, Roth B, Herting E, for the German Neonatal Network (GNN) (2015) Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants. Acta Paediatr 104(3):241–246. https://doi.org/10.1111/apa.12883 CrossRefPubMed

15.

Hall RW, Kronsberg S, Barton BA, Kaiser JR, Anand KJ (2005) Morphine, hypotension, and adverse outcomes among preterm neonates: who’s to blame? Secondary results from the NEOPAIN trial. Pediatrics 115(5):1351–1359CrossRefPubMed

16.

http://www.sqg.de/sqg/upload/CONTENT/Qualitaetsberichte/2013/AQUA-Qualitaetsreport-2013.pdf. Assessed 26 October 2017

17.

Isayama T, Iwami H, McDonald S, Beyene J (2016) Association of noninvasive ventilation strategies with mortality and bronchopulmonary dysplasia among preterm infants: a systematic review and meta-analysis. JAMA 316(6):611–624. https://doi.org/10.1001/jama.2016.10708 CrossRefPubMed

18.

Jobe AH, Bancalari E (2001) Bronchopulmonary dysplasia. Am J Respir Crit Care Med 163:1723–1729CrossRefPubMed

19.

Kanmaz HG, Erdeve O, Canpolat FE, Mutlu B, Dilmen U (2013) Surfactant administration via thin catheter during spontaneous breathing: randomized controlled trial. Pediatrics 131(2):e502–e509. https://doi.org/10.1542/peds.2012-0603 CrossRefPubMed

20.

Klebermass-Schrehof K, Wald M, Schwindt J, Grill A, Prusa AR, Haiden N, Hayde M, Waldhoer T, Fuiko R, Berger A (2013) Less invasive surfactant administration in extremely preterm infants: impact on mortality and morbidity. Neonatology 103(4):252–258. https://doi.org/10.1159/000346521 CrossRefPubMed

21.

Klotz D, Porcaro U, Fleck T, Fuchs H (2017) European perspective on less invasive surfactant administration—a survey. Eur J Pediatr 176(2):147–154. https://doi.org/10.1007/s00431-016-2812-9 CrossRefPubMed

22.

Kribs A (2011) How best to administer surfactant to VLBW infants? Arch Dis Child Fetal Neonatal Ed 96(4):F238–F240. https://doi.org/10.1136/adc.2010.209098 CrossRefPubMed

23.

Kribs A, Härtel C, Kattner E, Vochem M, Küster H, Möller J, Müller D, Segerer H, Wieg C, Gebauer C, Nikischin W, Wense A, Herting E, Roth B, Göpel W (2010) Surfactant without intubation in preterm infants with respiratory distress: first multi-center data. Klin Padiatr 222(1):13–17. https://doi.org/10.1055/s-0029-1241867 CrossRefPubMed

24.

Kribs A, Roll C, Göpel W, Wieg C, Groneck P, Laux R, Teig N, Hoehn T, Böhm W, Welzing L, Vochem M, Hoppenz M, Bührer C, Mehler K, Stützer H, Franklin J, Stöhr A, Herting E, Roth B, NINSAPP Trial Investigators (2015) Nonintubated surfactant application vs conventional therapy in extremely preterm infants: a randomized clinical trial. JAMA Pediatr 169(8):723–730. https://doi.org/10.1001/jamapediatrics.2015.0504 CrossRefPubMed

25.

Lista G, La Verde A, Castoldi F (2015) LISA: surfactant administration in spontaneous breathing. Which evidence from the literature? Acta Biomed 86(Suppl1):24–26PubMed

26.

Loepke AW (2010) Developmental neurotoxicity of sedatives and anesthetics: a concern for neonatal and pediatric critical care medicine? Pediatr Crit Care Med 11:217–226. https://doi.org/10.1097/PCC.0b013e3181b80383 CrossRefPubMed

27.

McIntire DD, Bloom SL, Casey BM, Leveno KJ (1999) Birth weight in relation to morbidity and mortality among newborn infants. N Engl J Med 340:1234–1238CrossRefPubMed

28.

Mehler K, Oberthuer A, Haertel C, Herting E, Roth B, Goepel W, German Neonatal Network (GNN) (2013) Use of analgesic and sedative drugs in VLBW infants in German NICUs from 2003–2010. Eur J Pediatr 172(12):1633–1639. https://doi.org/10.1007/s00431-013-2095-3 CrossRefPubMed

29.

More K, Sakhuja P, Shah PS (2014) Minimally invasive surfactant administration in preterm infants: a meta-narrative review. JAMA Pediatr 168(10):901–908. https://doi.org/10.1001/jamapediatrics.2014.1148 CrossRefPubMed

30.

Papile LA, Burstein J, Burstein R, Koffler H (1978) Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 g. J Pediatr 92(4):529–534CrossRefPubMed

31.

Rigo V, Lefebvre C, Broux I (2016) Surfactant instillation in spontaneously breathing preterm infants: a systematic review and meta-analysis. Eur J Pediatr 175(12):1933–1942CrossRefPubMed

32.

Stevens TP, Harrington EW, Blennow M, Soll RF (2007) 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 (4):CD003063

33.

Westby Wold SH, Sommerfelt K, Reidstad H et al (2009) Neonatal mortality and morbidity in extremely preterm small for gestational age infants: a population based study. Arch Dis Child Fetal Neonatal Ed 94(5):F363–F367. https://doi.org/10.1136/adc.2009.157800 CrossRefPubMed

34.

Zwicker JG, Miller SP, Grunau RE, Chau V, Brant R, Studholme C, Liu M, Synnes A, Poskitt KJ, Stiver ML, Tam EWY (2016) Smaller cerebellar growth and poorer neurodevelopmental outcomes in very preterm infants exposed to neonatal morphine. J Pediatr 172:81–87. https://doi.org/10.1016/j.jpeds.2015.12.02 CrossRefPubMedPubMedCentral

Title: Treatment and outcome data of very low birth weight infants treated with less invasive surfactant administration in comparison to intubation and mechanical ventilation in the clinical setting of a cross-sectional observational multicenter study
Authors: Kristina Langhammer
Bernhard Roth
Angela Kribs
Wolfgang Göpel
Ludwig Kuntz
Felix Miedaner
Publication date: 01-08-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Pediatrics / Issue 8/2018
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-018-3179-x

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Treatment and outcome data of very low birth weight infants treated with less invasive surfactant administration in comparison to intubation and mechanical ventilation in the clinical setting of a cross-sectional observational multicenter study

Abstract

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Abstract

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