Prophylactic oropharyngeal surfactant with continuous positive airway pressure in preterm infants
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Reviewed by Dat Tien Nguyen, B.A, ScM.
Translated by Nhi Phuong Quynh Le, B.A |
Posted on February 12th, 2024
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Preterm infants face an increased risk of neonatal respiratory distress syndrome due to their underdeveloped lung status. The conventional management approach, continuous positive airway pressure (CPAP), yields suboptimal outcomes in neonates. Given their deficient surfactant levels—a crucial blend of phospholipids and proteins preventing alveolar collapse—intubation becomes necessary for surfactant administration. Nevertheless, neonatal endotracheal intubation is linked to various adverse effects. Consequently, a study investigates the potential enhancement of respiratory outcomes through the prophylactic administration of oropharyngeal surfactant before applying CPAP.
The study comprised 251 neonates born before 29 weeks of gestational age and free from congenital abnormalities. Over 60% of these infants were delivered via cesarean section, with an average birth weight of approximately 800 grams. Through random assignment, these newborns were divided into groups receiving either CPAP alone or CPAP with additional surfactant administration at birth. Poractant alfa was delivered directly to the oropharynx through a catheter, with a dosage of 120 mg for those under 26 weeks of gestational age and an increased dosage of 240 mg for those between 26 and 28 weeks. The study reported an intubation rate of 63.5% in the oropharyngeal surfactant group and 64.8% in the control group five days after birth. Due to an elevated risk of pneumothorax, the researchers concluded that routine use of prophylactic oropharyngeal surfactant with CPAP should be avoided in the care of preterm infants. The researchers speculated that aspiration might have hindered surfactant delivery to the lungs, contributing to high variability among the infants.
The study comprised 251 neonates born before 29 weeks of gestational age and free from congenital abnormalities. Over 60% of these infants were delivered via cesarean section, with an average birth weight of approximately 800 grams. Through random assignment, these newborns were divided into groups receiving either CPAP alone or CPAP with additional surfactant administration at birth. Poractant alfa was delivered directly to the oropharynx through a catheter, with a dosage of 120 mg for those under 26 weeks of gestational age and an increased dosage of 240 mg for those between 26 and 28 weeks. The study reported an intubation rate of 63.5% in the oropharyngeal surfactant group and 64.8% in the control group five days after birth. Due to an elevated risk of pneumothorax, the researchers concluded that routine use of prophylactic oropharyngeal surfactant with CPAP should be avoided in the care of preterm infants. The researchers speculated that aspiration might have hindered surfactant delivery to the lungs, contributing to high variability among the infants.