Effect of surfactant therapy using an orogastric tube for tracheal catheterization in preterm newborns with respiratory distress
Abstract
Introduction: Respiratory distress syndrome (RDS) due to surfactant deficiency requires surfactant therapy for which InSurE method (Intubate, Surfactant, Extubate) has been widely used. However this method requires intubation and positive pressure ventilation, even for a short time which is enough to initiate significant lung injury. Recently, surfactant administration by Minimally Invasive Surfactant Therapy (MIST) using a fine catheter under direct laryngoscopy in spontaneously breathing preterms while on nCPAP has reported good outcomes. We prospectively assessed the outcome of a modified MIST method of surfactant administration using an orogastric tube in preterms with RDS.
Materials & Methods: A single centre, prospective observational study was conducted where all consecutive eligible inborn preterm neonates with gestation age more than 24 weeks but less than 34 weeks and suffering from RDS were enrolled to receive surfactant using MIST. Results were compared with a historical cohort of preterm who received surfactant with INSURE techniques.
Results: Sixty four cases in the modified MIST group were compared with a historic cohort of 68 cases in INSURE group. There were no differences in the requirement of intubation and mechanical ventilation in the first 72 hours but the duration of MV and CPAP were significantly less in modified MIST group. Other neonatal morbidities and mortality rates were similar in either of the groups.
Conclusion: The modified MIST technique is an effective method for the treatment of RDS in preterms with better clinical efficacy and comparable outcomes than the more invasive INSURE procedure and deserves further evaluation.
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