Am J Perinatol 2020; 37(03): 277-280
DOI: 10.1055/s-0039-1678534
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Less Invasive Surfactant Administration in Spain: A Survey Regarding Its Practice, the Target Population, and Premedication Use

1   Department of Neonatology, Vall d'Hebron University Hospital, Barcelona, Spain
,
1   Department of Neonatology, Vall d'Hebron University Hospital, Barcelona, Spain
,
Fatima Camba
1   Department of Neonatology, Vall d'Hebron University Hospital, Barcelona, Spain
,
Juan Jose Comuñas
1   Department of Neonatology, Vall d'Hebron University Hospital, Barcelona, Spain
,
Felix Castillo
1   Department of Neonatology, Vall d'Hebron University Hospital, Barcelona, Spain
› Author Affiliations
Further Information

Publication History

22 June 2018

03 January 2019

Publication Date:
04 February 2019 (online)

Abstract

Objective Scientific evidence supports the use of less invasive surfactant administration (LISA) techniques, but certain issues may be limiting its generalized incorporation in clinical practice. The objectives were to determine the level of acceptance of LISA techniques in Spanish hospitals, the types of methods used, the target population, and the premedication administered.

Study Design An online survey was designed and sent to various secondary/tertiary hospitals in Spain.

Results Among 67 neonatal units contacted, 44 (65.7%) participated. LISA was used in 89%, and those that did not perform the technique were contemplating its use in the future. In total, 77% of hospitals used some type of pharmacologic sedation/analgesia before the procedure: 28% always and 49% sometimes. In all cases, the reason for premedication was concerned about pain and discomfort. The types of drugs and doses varied.

Conclusion LISA has been incorporated in clinical practice of the hospitals surveyed, with a utilization rate higher than what has been reported to date. Sedation and analgesia are commonly administered. LISA is viewed as potentially involving some degree of pain and discomfort. Further studies are needed to determine the safest and most effective pharmacologic and nonpharmacologic measures to apply in these procedures.

 
  • References

  • 1 Rojas-Reyes MX, Morley CJ, Soll R. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2012; (03) CD000510
  • 2 Attar MA, Donn SM. Mechanisms of ventilator-induced lung injury in premature infants. Semin Neonatol 2002; 7 (05) 353-360
  • 3 Sweet DG, Carnielli V, Greisen G. , et al. European consensus guidelines on the management of respiratory distress syndrome - 2016 update. Neonatology 2017; 111 (02) 107-125
  • 4 Aldana-Aguirre JC, Pinto M, Featherstone RM, Kumar M. Less invasive surfactant administration versus intubation for surfactant delivery in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2017; 102 (01) F17-F23
  • 5 Kanmaz HG, Erdeve O, Canpolat FE, Mutlu B, Dilmen U. Surfactant administration via thin catheter during spontaneous breathing: randomized controlled trial. Pediatrics 2013; 131 (02) e502-e509
  • 6 Isayama T, Iwami H, McDonald S, Beyene J. Association of noninvasive ventilation strategies with mortality and bronchopulmonary dysplasia among preterm infants: a systematic review and meta-analysis. JAMA 2016; 316 (06) 611-624
  • 7 Göpel W, Kribs A, Ziegler A. , et al; German Neonatal Network. Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. Lancet 2011; 378 (9803): 1627-1634
  • 8 Dargaville PA, Aiyappan A, De Paoli AG. , et al. Minimally-invasive surfactant therapy in preterm infants on continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed 2013; 98 (02) F122-F126
  • 9 Klebermass-Schrehof K, Wald M, Schwindt J. , et al. Less invasive surfactant administration in extremely preterm infants: impact on mortality and morbidity. Neonatology 2013; 103 (04) 252-258
  • 10 Kumar P, Denson SE, Mancuso TJ. ; Committee on Fetus and Newborn, Section on Anesthesiology and Pain Medicine. Premedication for nonemergency endotracheal intubation in the neonate. Pediatrics 2010; 125 (03) 608-615
  • 11 Rite Garía S, Fernández Lorenzo JR, Echániz I. , et al. Niveles asistenciales y recomendacions de mínimos ara la atención neonatal. An Pediatr (Barc) 2013; 79 (01) 51.e1-51.e11
  • 12 American Academy of Pediatrics. Committe on fetus and newborn. Levels of Neonatal Care. Pediatrics 2012; 130: 587-59
  • 13 Klotz D, Porcaro U, Fleck T, Fuchs H. European perspective on less invasive surfactant administration-a survey. Eur J Pediatr 2017; 176 (02) 147-154
  • 14 Borszewska-Kornacka MK, Kostuch M, Korbal P, Krajewski P. ; Polish RDS Study Group. Strategies of using surfactant results of the first polish national survey of daily practice. Dev Period Med 2015; 19 (3 Pt 1): 271-276
  • 15 Heiring C, Jonsson B, Andersson S, Björklund LJ. Survey shows large differences between the Nordic countries in the use of less invasive surfactant administration. Acta Paediatr 2017; 106 (03) 382-386
  • 16 Kelly MA, Finer NN. Nasotracheal intubation in the neonate: physiologic responses and effects of atropine and pancuronium. J Pediatr 1984; 105 (02) 303-309
  • 17 Kribs A, Roll C, Göpel W. , et al; NINSAPP Trial Investigators. Nonintubated surfactant application vs conventional therapy in extremely preterm infants: a randomized clinical trial. JAMA Pediatr 2015; 169 (08) 723-730
  • 18 Stow PJ, McLeod ME, Burrows FA, Creighton RE. Anterior fontanelle pressure responses to tracheal intubation in the awake and anaesthetized infant. Br J Anaesth 1988; 60 (02) 167-170
  • 19 Friesen RH, Honda AT, Thieme RE. Changes in anterior fontanel pressure in preterm neonates during tracheal intubation. Anesth Analg 1987; 66 (09) 874-878
  • 20 Marshall TA, Deeder R, Pai S, Berkowitz GP, Austin TL. Physiologic changes associated with endotracheal intubation in preterm infants. Crit Care Med 1984; 12 (06) 501-503
  • 21 Millar C, Bissonnette B. Awake intubation increases intracranial pressure without affecting cerebral blood flow velocity in infants. Can J Anaesth 1994; 41 (04) 281-287
  • 22 COMMITTEE ON FETUS AND NEWBORN and SECTION ON ANESTHESIOLOGY AND PAIN MEDICINE. Prevention and management of procedural pain in the neonate: an update. Pediatrics 2016; 137 (02) e20154271
  • 23 Dekker J, Lopriore E, Rijken M, Rijntjes-Jacobs E, Smits-Wintjens V, Te Pas A. Sedation during minimal invasive surfactant therapy in preterm infants. Neonatology 2016; 109 (04) 308-313
  • 24 de Kort EH, Reiss IK, Simons SH. Sedation of newborn infants for the INSURE procedure, are we sure?. BioMed Res Int 2013; 2013: 892974
  • 25 Ghanta S, Abdel-Latif ME, Lui K, Ravindranathan H, Awad J, Oei J. Propofol compared with the morphine, atropine, and suxamethonium regimen as induction agents for neonatal endotracheal intubation: a randomized, controlled trial. Pediatrics 2007; 119 (06) e1248-e1255
  • 26 Welzing L, Kribs A, Eifinger F, Huenseler C, Oberthuer A, Roth B. Propofol as an induction agent for endotracheal intubation can cause significant arterial hypotension in preterm neonates. Paediatr Anaesth 2010; 20 (07) 605-611