A new minimally-invasive method of delivering surfactant* is safe and could reduce the need for mechanical ventilation that can cause lung damage and result in breathing problems and chronic lung disease, according to the Avoiding Mechanical Ventilation (AMV) trial published Online First in The Lancet.
Because their lungs are not fully developed, premature babies are at increased risk of developing respiratory distress syndrome. These babies do not produce enough surfactant, a substance that prevents the collapse of air sacs in the lungs and improves lung function. Traditionally, surfactant is given through a tube in the windpipe during mechanical ventilation, but this method requires sedation and intubation, and can damage the lungs.
Continuous positive airway pressure (CPAP) is an alternative non-invasive method of ventilation that involves pushing air and/or oxygen through the nose to gently inflate the lungs while babies are breathing by themselves. Until now, a disadvantage of CPAP was that without intubation babies had not been treated with surfactant.
The AMV trial was designed to test a new method of surfactant delivery without the use of an endotracheal tube or mechanical ventilation. The new technique involves giving surfactant early to spontaneously breathing premature babies on CPAP through a thin catheter inserted into the windpipe that is removed quickly, as soon as the surfactant is delivered.
Between October 2007, and January 2008, 220 premature babies (gestational age between 26 and 28 weeks) were enrolled from 12 neonatal intensive care units across Germany and randomly assigned to receive either standard treatment (112 babies; rescue intubation, then surfactant if needed during mechanical ventilation) or intervention (108 babies; early administration of surfactant during spontaneous breathing).
Findings showed that on day 2 or 3 after birth, babies in the intervention group were significantly less likely to be mechanically ventilated compared with those given standard treatment (28% vs 46%), and also less likely to need mechanical ventilation during the rest of their hospital stay.
Additionally, babies given the new treatment spent significantly less time on mechanical ventilation, and had a lower need for oxygen at 28 days (30% vs 45%).
The authors conclude: "In the future, surfactant given to spontaneously breathing preterm infants via a thin diameter tube might be included in individualised and gentler care for preterm infants."
In a Comment, Filip Cools from Universitair Ziekenhuis Brussel, Brussels, Belgium says: "[This] study provides new and valuable information about the safety and the short-term effects of a minimally invasive method of surfactant administration. However, more information is needed before it can be used in clinical practice. New studies should further optimise the study design, focus on more specific populations of preterm infants, use clearly defined and robust outcome measures, and address the long-term effects of this intervention."
Professor Egbert Herting, University of Lübeck, Lübeck, Germany. T) +49 451 5002545 or +49 178 2517558 (mobile) E) herting@paedia.ukl.mu-luebeck.de or egbertherting@aol.com
Dr Filip Cools, Universitair Ziekenhuis Brussel, Brussels, Belgium. T) +32 2 4763276 E) filip.cools@uzbrussel.be
Notes to Editors
*Surfactant is a secretion lining the surface of the lungs that is necessary for breathing, and that premature babies often lack.
Journal
The Lancet