Alternative routes of surfactant application - An update.

Non-invasive modes of respiratory support have been shown to be the preferable way of primary respiratory support of preterm infants with respiratory distress syndrome (RDS). The avoidance of invasive mechanical ventilation can be beneficial for preterm infants in reduction of morbidity and even mortality. However, it is well-established that some infants managed with non-invasive respiratory support from the outset have symptomatic RDS to a degree that warrants surfactant administration. Infants for whom non-invasive respiratory support ultimately fails are prone to adverse outcomes, occurring at a frequency on par with the group intubated primarily. This raises the question how to combine non-invasive respiratory support with surfactant therapy. Several methods of less or minimally invasive surfactant therapy have been developed to address the dilemma between avoidance of mechanical ventilation and administration of surfactant. This paper describes the different methods of less invasive surfactant application, reports the existing evidence from clinical studies, discusses the limitations of each of the methods and the open and future research questions.

Informations de copyright

Copyright © 2023. Published by Elsevier Ltd.

Déclaration de conflit d'intérêts

Conflict of interest statements AK received support for attending meetings from Chiesi Farmaceutici and served as a consultant on advisory boards established by Chiesi. KR is paid consultant for ONY Biotech for device development. DT has no conflict. COD has no conflict of interest to declare. Chiesi Farmaceutici, Parma, Italia, manufacturers of poractant alfa (Curosurf), the investigational medicinal product studied in the POPART trial, provided the oropharyngeal surfactant free of charge for the study. They had no role in study design, data collection, analysis, interpretation or the decisions to present or publish the results. PD received support for attending meetings from Chiesi Farmaceutici; served as a consultant on advisory boards established by Chiesi and AbbVie; holds (without royalty claims) a design patent for a catheter for surfactant instillation. Received support for the OPTIMIST-A trial from Chiesi (provision of surfactant at reduced cost). The OPTIMIST-A trial funders had no role in the design and conduct of the study.