Articles

Surfactant Administration in Preterm Neonates Using Laryngeal Mask Airway: A Randomized Clinical Trial

Abstract

In this study, we aimed to compare the efficacy of laryngeal mask airway (LMA) versus endotracheal tube in the early rescue surfactant administration in premature neonates with respiratory distress syndrome (RDS). This randomized, clinical trial evaluated 60 premature neonates with RDS. Numbered envelopes randomly assigned 30 neonates to the intervention group to receive 2.5 ml/kg/dose surfactant (Curosurf) via LMA and 30 to the control group to receive 2.5 ml/kg/dose surfactant via an endotracheal tube using the INSURE technique, exclusively during the first two hours of life. There were no differences in the requirement for mechanical ventilation (23.3% vs. 20%, P=0.75), requirement for second dose surfactant (13.3% vs. 6.7%, P=0.67), bronchopulmonary dysplasia (13.3% vs. 6.7%, P=0.67), pneumothorax (6.7% vs. 0%, P=0.49), and intraventricular hemorrhage (10% vs. 10%, P=1) between neonates who received surfactant via LMA versus those who received surfactant via endotracheal tube. LMA seems to be an effective and less invasive alternative to endotracheal intubation for surfactant delivery in premature neonates with RDS.

References

Ghafoor T, Mahmud S, Ali S, Dogar SA. Incidence of respiratory distress syndrome. J Coll Physicians Surg Pak. 2003 May;13(5):271–3.

Polin RA, Carlo WA, Committee on Fetus and Newborn, American Academy of Pediatrics. Surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics. 2014 Jan;133(1):156–63.

Biban P, Chini L, Bonetti P, Sacco F, Zaglia F, Santuz P. Exogenous surfactant replacement: how to deliver it? Acta Biomed. 2012;83 Suppl 1:27–32.

Brimacombe J, Gandini D, Keller C. The laryngeal mask airway for administration of surfactant in two neonates with respiratory distress syndrome. Paediatr Anaesth. 2004 Feb;14(2):188–90.

Barbosa RF, Marcatto J de O, Silva ACSE, Silva YPE. ProSealTM laryngeal mask airway for surfactant administration in the treatment of respiratory distress syndrome in a premature infant. Rev Bras Ter Intensiva. 2012 Jun;24(2):207–10.

Trevisanuto D, Grazzina N, Ferrarese P, Micaglio M, Verghese C, Zanardo V. Laryngeal mask airway used as a delivery conduit for the administration of surfactant to preterm infants with respiratory distress syndrome. Biol Neonate. 2005;87(4):217–20.

Sadeghnia A, Tanhaei M, Mohammadizadeh M, Nemati M. A comparison of surfactant administration through i-gel and ET-tube in the treatment of respiratory distress syndrome in newborns weighing more than 2000 grams. Adv Biomed Res [Internet]. 2014 Jul 31 [cited 2018 Sep 7];3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4162081/

Pinheiro JMB, Santana-Rivas Q, Pezzano C. Randomized trial of laryngeal mask airway versus endotracheal intubation for surfactant delivery. J Perinatol. 2016 Mar;36(3):196–201.

Barbosa RF, Simões E Silva AC, Silva YP. A randomized controlled trial of the laryngeal mask airway for surfactant administration in neonates. J Pediatr (Rio J). 2017 Aug;93(4):343–50.

Attridge JT, Stewart C, Stukenborg GJ, Kattwinkel J. Administration of rescue surfactant by laryngeal mask airway: lessons from a pilot trial. Am J Perinatol. 2013 Mar;30(3):201–6.

Roberts KD, Brown R, Lampland AL, Leone TA, Rudser KD, Finer NN, et al. Laryngeal Mask Airway for Surfactant Administration in Neonates: A Randomized, Controlled Trial. J Pediatr. 2018 Feb;193:40-46.e1.

Abdel-Latif ME, Osborn DA. Laryngeal mask airway surfactant administration for prevention of morbidity and mortality in preterm infants with or at risk of respiratory distress syndrome. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD008309.

Schmölzer GM, Agarwal M, Kamlin COF, Davis PG. Supraglottic airway devices during neonatal resuscitation: an historical perspective, systematic review and meta-analysis of available clinical trials. Resuscitation. 2013 Jun;84(6):722–30.

More K, Sakhuja P, Shah PS. Minimally invasive surfactant administration in preterm infants: a meta-narrative review. JAMA Pediatr. 2014 Oct;168(10):901–8.

Kattwinkel J, Bloom RS, American Academy of Pediatrics, American Heart Association. Textbook of neonatal resuscitation [Internet]. Elk Grove Village, Ill.]; [Dallas, Tex.: American Academy of Pediatrics ; American Heart Association; 2011 [cited 2018 Sep 7]. Available from: http://site.ebrary.com/id/10635877

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 Mar;125(3):608–15.

Solimano A, ACoRN Editorial Board, ACoRN Neonatal Society. ACoRN: acute care of at-risk newborns. 2012.

Goldsmith JP, Karotkin E. Assisted Ventilation of the Neonate. Elsevier Health Sciences; 2016. 658 p.

Fujiwara T, Maeta H, Chida S, Morita T, Watabe Y, Abe T. Artificial surfactant therapy in hyaline-membrane disease. Lancet. 1980 Jan 12;1(8159):55–9.

Verder H, Agertoft L, Albertsen P, Christensen NC, Curstedt T, Ebbesen F, et al. [Surfactant treatment of newborn infants with respiratory distress syndrome primarily treated with nasal continuous positive air pressure. A pilot study]. Ugeskr Laeg. 1992 Jul 27;154(31):2136–9.

Roberts KD, Lampland AL, Meyers PA, Worwa CT, Plumm BJ, Mammel MC. Laryngeal mask airway for surfactant administration in a newborn animal model. Pediatr Res. 2010 Nov;68(5):414–8.

Chen L, Hsiao AL. Randomized trial of endotracheal tube versus laryngeal mask airway in simulated prehospital pediatric arrest. Pediatrics. 2008 Aug;122(2):e294-297.

Zimmert M, Zwirner P, Kruse E, Braun U. Effects on vocal function and incidence of laryngeal disorder when using a laryngeal mask airway in comparison with an endotracheal tube. Eur J Anaesthesiol. 1999 Aug;16(8):511–5.

Akbar AN, Muzi M, Lopatka CW, Ebert TJ. Neurocirculatory responses to intubation with either an endotracheal tube or laryngeal mask airway in humans. J Clin Anesth. 1996 May;8(3):194–7.

Blanchard N, Jezraoui P, Milazzo S, Daelman F, Rajaonarivony D, Ossart M. [Changes in intraocular pressure during anesthesia with intratracheal intubation or laryngeal mask]. Ann Fr Anesth Reanim. 1996;15(7):1008–12.

Wanous AA, Wey A, Rudser KD, Roberts KD. Feasibility of Laryngeal Mask Airway Device Placement in Neonates. Neonatology. 2017;111(3):222–7.

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IssueVol 57, No 6 (2019) QRcode
SectionArticles
DOI https://doi.org/10.18502/acta.v57i6.1877
Keywords
Infants Intubation LMA Premature Preterm Surfactant

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How to Cite
1.
Amini E, Sheikh M, Shariat M, Dalili H, Azadi N, Nourollahi S. Surfactant Administration in Preterm Neonates Using Laryngeal Mask Airway: A Randomized Clinical Trial. Acta Med Iran. 2019;57(6):348-354.