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American Academy of Pediatrics
Article

Surfactant Administration via Thin Catheter During Spontaneous Breathing: Randomized Controlled Trial

H. Gozde Kanmaz, Omer Erdeve, F. Emre Canpolat, Banu Mutlu and Ugur Dilmen
Pediatrics February 2013, 131 (2) e502-e509; DOI: https://doi.org/10.1542/peds.2012-0603
H. Gozde Kanmaz
aDivision of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, and
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Omer Erdeve
bDivision of Neonatology, Ankara University School of Medicine, Ankara, Turkey; and
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F. Emre Canpolat
aDivision of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, and
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Banu Mutlu
aDivision of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, and
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Ugur Dilmen
aDivision of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, and
cDepartment of Pediatrics, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
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Abstract

BACKGROUND: The primary aim of this randomized study was to describe the feasibility of early administration of surfactant via a thin catheter during spontaneous breathing (Take Care) and compare early mechanical ventilation (MV) requirement with the InSurE (Intubate, Surfactant, Extubate) procedure.

METHODS: Preterm infants, who were <32 weeks and stabilized with nasal continuous positive airway pressure (nCPAP) in the delivery room, were randomized to receive early surfactant treatment either by the Take Care or InSurE technique. Tracheal instillation of 100 mg/kg poractant α via 5-F catheter during spontaneous breathing under nCPAP was performed in the intervention group. In the InSurE procedure, infants were intubated, received positive pressure ventilation for 30 seconds after surfactant instillation, and placed on nCPAP immediately.

RESULTS: One hundred infants in each group were analyzed. The MV requirement in the first 72 hours of life was significantly lower in the Take Care group when compared with the InSurE group (30% vs 45%, P = .02, odds ratio –0.52, 95% confidence interval –0.94 to –0.29). Mean duration of both nCPAP and MV were significantly shorter in the Take Care group (P values .006 and .002, respectively). Bronchopulmonary dysplasia rate was significantly lower among the infants treated with the Take Care technique (relative risk –0.27, 95% confidence interval –0.1 to –0.72)

CONCLUSIONS: The Take Care technique is feasible for the treatment of respiratory distress syndrome in infants with very low birth weight. It significantly reduces both the need and duration of MV, and thus the bronchopulmonary dysplasia rate in preterm infants.

KEY WORDS
  • surfactant
  • InSurE
  • bronchopulmonary dysplasia
  • preterm
  • spontaneous breathing
  • mechanical ventilation
  • Abbreviations:
    BPD —
    bronchopulmonary dysplasia
    DR —
    delivery room
    FiO2 —
    fraction of inspired oxygen
    GA —
    gestational age
    InSurE —
    intubate, surfactant, extubate
    MV —
    mechanical ventilation
    nCPAP —
    nasal continuous positive airway pressure
    PEEP —
    positive end-expiratory pressure
    PPV —
    positive pressure ventilation
    RDS —
    respiratory distress syndrome
    RR —
    relative risk
    SpO2 —
    oxygen saturation
    • Accepted October 5, 2012.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 131, Issue 2
    1 Feb 2013
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    Surfactant Administration via Thin Catheter During Spontaneous Breathing: Randomized Controlled Trial
    H. Gozde Kanmaz, Omer Erdeve, F. Emre Canpolat, Banu Mutlu, Ugur Dilmen
    Pediatrics Feb 2013, 131 (2) e502-e509; DOI: 10.1542/peds.2012-0603

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    Surfactant Administration via Thin Catheter During Spontaneous Breathing: Randomized Controlled Trial
    H. Gozde Kanmaz, Omer Erdeve, F. Emre Canpolat, Banu Mutlu, Ugur Dilmen
    Pediatrics Feb 2013, 131 (2) e502-e509; DOI: 10.1542/peds.2012-0603
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    Subjects

    • Fetus/Newborn Infant
      • Fetus/Newborn Infant

    Keywords

    • surfactant
    • InSurE
    • bronchopulmonary dysplasia
    • preterm
    • spontaneous breathing
    • mechanical ventilation
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