Document Detail

Technique for intrapartum administration of surfactant without requirement for an endotracheal tube.
MedLine Citation:
PMID:  15085166     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate the feasibility and safety of administering surfactant into the nasopharynx during delivery, thus permitting the baby to aspirate the solution into the fluid-filled airway as an air-fluid interface is established. This process avoids the endotracheal intubation (ETI) and positive pressure ventilation (PPV) usually associated with prophylaxis, thus avoiding the pulmonary barotrauma associated with the conventional method of surfactant administration. STUDY DESIGN: In all, 23 neonates weighing 560 to 1804 g and born at 27 to 30 weeks had their nasopharyngeal airways suctioned and then 3.0-4.5 ml Infasurf instilled into the nasopharynx before delivery of the shoulders. Continuous positive airway pressure (CPAP) of 10 cmH(2)O was administered by mask as the babies initiated breathing. Nasal CPAP at 6 cmH(2)O was then continued for a minimum of 48 hours. RESULTS: In all, 13 of 15 babies delivered vaginally were weaned quickly to room air and required no further surfactant or endotracheal intubation for RDS. Five of eight babies delivered by C-section required subsequent endotracheal intubation soon after birth and two received subsequent endotracheal tube surfactant. CONCLUSION: Nasopharyngeal surfactant instillation at birth appears to be relatively safe and simple to accomplish, especially for vaginal births. A large randomized clinical trial will be required to determine the efficacy of this technique when compared to prophylaxis by endotracheal intubation and to nCPAP alone.
John Kattwinkel; Melinda Robinson; Barry T Bloom; Paula Delmore; James E Ferguson
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of perinatology : official journal of the California Perinatal Association     Volume:  24     ISSN:  0743-8346     ISO Abbreviation:  J Perinatol     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-05-28     Completed Date:  2004-09-30     Revised Date:  2005-08-30    
Medline Journal Info:
Nlm Unique ID:  8501884     Medline TA:  J Perinatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  360-5     Citation Subset:  IM    
Department of Pediatrics, University of Virginia, Box 800386, Charlottesville, VA 22908, USA.
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MeSH Terms
Biological Products / administration & dosage*
Continuous Positive Airway Pressure
Delivery, Obstetric*
Infant, Newborn
Infant, Premature*
Instillation, Drug
Intubation, Intratracheal
Respiratory Distress Syndrome, Newborn / therapy*
Reg. No./Substance:
0/Biological Products; 0/calfactant
Comment In:
J Perinatol. 2005 May;25(5):361-2; author reply 363   [PMID:  15861205 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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