medwireNews: Minimally invasive surfactant therapy (MIST) does not reduce the incidence of death or neurodevelopmental disability (NDD) at 2 years of age among preterm infants supported with continuous positive airway pressure (CPAP), shows a follow-up of the OPTIMIST-A trial.
“However, infants who received MIST had lower rates of adverse respiratory outcomes during their first 2 years of life,” report Peter Dargaville (Royal Hobart Hospital, Tasmania, Australia) and co-authors in JAMA.
The follow-up study included data for 453 (93.2%) of the 486 infants with respiratory distress syndrome who took part in the international OPTIMIST-A trial. They had a gestational age of 25.0 to 28.0 weeks (median 27.3 weeks), were supported with CPAP, and were randomly assigned to receive exogenous surfactant via a thin catheter (200 mg/kg poractant alfa, n=224) or sham treatment consisting of transient repositioning without airway instrumentation (n=229).
The researchers found that, at 2 years’ corrected age, there was no significant difference between the groups in the incidence of death or moderate-to-severe NDD, defined as cognitive or language impairment, cerebral palsy equivalent to Gross Motor Function Classification System level of 2 or greater, visual impairment, or hearing impairment. Specifically, the composite outcome occurred in 36.3% of infants in the MIST group and 36.1% of those in the control group.
There were also no significant differences between the two groups in the individual components of the composite outcome. Death prior to 2 years’ corrected age occurred in 12.9% of participants in the MIST group and 10.5% of those in the control group, while NDD occurred in a respective 26.3% and 28.2%.
In addition, incidence of the subcomponents of the NDD outcome were similar between infants in the MIST and control groups.
However, the team observed that respiratory health in the first 2 years was significantly better among the infants given MIST rather than sham treatment.
The relative risk for hospitalization with respiratory illness was a significant 34% lower in the MIST arm than in the control arm, at rates of 25.1% versus 38.2%, while the risk for parent-reported wheezing or breathing difficulty was a significant 24% lower, occurring in 40.6% versus 53.6%.
The incidence of physician-diagnosed asthma was also significantly lower in the MIST arm compared with the control arm, at 4.4% versus 11.9%, with the difference corresponding to a 63% lower relative risk in favor of MIST.
Dargaville et al suggest that “the application of MIST on the first day of life appears to have attenuated lung injury.”
They say: “This is likely related to the lessening of exposure to positive pressure ventilation in the critical first days of life, with the rate of intubation at less than 72 hours being nearly halved in the MIST group compared with the control group (37% vs 72%).”
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