Prophylactic surfactant nebulisation for the early aeration of the preterm lung: a randomised clinical trial.

Autor: Gaertner VD; Newborn Research Zurich, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland vincent.gaertner@usz.ch., Minocchieri S; Department of Neonatology, Cantonal Hospital Winterthur, Winterthur, Switzerland., Waldmann AD; Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany., Mühlbacher T; Newborn Research Zurich, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland., Bassler D; Newborn Research Zurich, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland., Rüegger CM; Newborn Research Zurich, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland.
Jazyk: angličtina
Zdroj: Archives of disease in childhood. Fetal and neonatal edition [Arch Dis Child Fetal Neonatal Ed] 2023 May; Vol. 108 (3), pp. 217-223. Date of Electronic Publication: 2022 Nov 24.
DOI: 10.1136/archdischild-2022-324519
Abstrakt: Objective: The effect of prophylactic surfactant nebulisation (SN) is unclear. We aimed to determine whether prophylactic SN improves early lung aeration.
Design: Parallel, randomised clinical trial, conducted between March 2021 and January 2022.
Setting: Delivery room (DR) of a tertiary neonatal centre in Zurich, Switzerland.
Patients: Preterm infants between 26 0/7 and 31 6/7 weeks gestation INTERVENTIONS: Infants were randomised to receive positive distending pressure alone or positive distending pressure and additional SN (200 mg/kg; poractant alfa) using a customised vibrating membrane nebuliser. SN commenced with the first application of a face mask immediately after birth.
Main Outcome Measures: Primary outcome was the difference in end-expiratory lung impedance from birth to 30 min after birth (∆EELI 30min ). EELI correlates well with functional residual capacity. Secondary outcomes included physiological and clinical outcomes.
Results: Data from 35 infants were collected, and primary outcome data were analysed from 32 infants (n=16/group). Primary outcome was not different between intervention and control group (median (IQR): 25 (7-62) vs 10 (0-26) AU/kg, p=0.21). ∆EELI was slightly higher in the intervention group at 6 and 12 hours after birth, particularly in the central areas of the lung. There were no differences in cardiorespiratory and clinical parameters. Two adverse events were noted in the intervention group.
Conclusions: Prophylactic SN in the DR did not significantly affect ∆EELI 30min and showed only minimal effects on lung physiology. Prophylactic SN in the DR was feasible. There were no differences in clinical outcomes.
Trial Registration Number: NCT04315636.
Competing Interests: Competing interests: The nebulisers were provided free of charge by PARI Pharma and the EIT monitor and belts were provided by SenTec AG.
(© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze: MEDLINE
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