Early Cpap and Large Volume Minimal Invasive Surfactant Administration (Ecalmist)

Abstract

Yahya Ethawi, Abrar Hussain, John Minski, Joe Miller and Ruben Alvaro

Large volume surfactant administration in premature infants less than 35 weeks using minimally invasive surfactant therapy (MIST).

Background: Surfactant in small volume preparations can be successfully administered to premature infants using a narrow-bore vascular catheter inserted into the trachea under direct vision. It was not known if surfactant in large volume preparations could be administered effectively to spontaneously breathing premature infants while maintaining them on nasal continuous positive airway pressure (nCPAP).

Objective: To evaluate the feasibility of administering a large volume of surfactant (5 ml/kg) in spontaneously breathing premature infants on nCPAP using a vascular catheter.

Methods: Single-arm interventional trial in two level III nurseries in Canada. Spontaneously breathing premature infants between 24- and 34-weeks’ gestation, born between July 4th, 2012 and September 5th, 2012 were eligible for the trial in the first 24 hours of life. A 16-gauge vascular catheter was inserted under direct vision through the vocal cords to administer 5 ml/kg of surfactant while maintaining the infants on nCPAP.

Results: Twenty-one premature infants were enrolled. The mean gestational age was 29 ± 3 (range 24 to 34 weeks) with mean birth weight of 1474 ± 575 g. Surfactant was successfully administered in 20 infants (95 %). There was a clear effect after surfactant administration with a decrease in oxygen requirement from 0.34 ± 0.111 before the procedure, to 0.26 ± 0.08 after the procedure (p = .001), and a decrease in nCPAP pressure from 7.2 ± 0.5 cm H2O before the procedure to 5.9 ± 0.5 after the procedure (p < .0001). The mean duration for surfactant administration was 8.3 ± 3.4 minutes. The procedure was temporarily stopped in three cases due to bradycardia and/or apnea with desaturations that spontaneously recovered without intervention. Coughing and reflux of the surfactant were transiently observed in four cases (19 %).

Conclusion: It is feasible to administer large volumes of surfactant without interrupting nCPAP via a vascular catheter, to premature infants less than 35 weeks’ gestation. Further trials are needed to confirm the safety and efficacy of this method compared to other methods of surfactant administration.

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