Preventing Mechanical Ventilation in Newborns

This is lovely article regarding the treatment of respiratory distress in newborns.  It is not a new concept to use surfactant in clinically indicated situations to improve ventilation in the newborn in distress – however, the typical treatment involves endotracheal intubation and mechanical ventilation prior to application.  This is a randomized, controlled trial of surfactant administration prior to mechanical ventilation.

This involves 220 preterm infants in Germany who were selected for the trial, essentially, if they were on CPAP requiring more than 30% inspired O2.  In the intervention group, patients received intratracheal surfactant if stable on CPAP and 30% O2.  Outcome measures were the portion of patients mechanically ventilated at any time or at day 2 or 3 after birth.  Minimal differences between groups, although the control group was a few grams lighter at birth.

Overall, 33% of all intervention infants required mechanical intervention vs. 73% of the control group.

Simple takeaway – surfactant isn’t just useful after intubation, but may also prevent mechanical ventilation.

“Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial”
www.ncbi.nlm.nih.gov/pubmed/21963186