Early Surfactant Guided by Lamellar Body Counts on Gastric Aspirate in Very Preterm Infants

• Published in: Neonatology (Basel, Switzerland) Vol. 104; no. 2; pp. 116 - 122
• Main Authors: Verder, Henrik, Ebbesen, Finn, Fenger-Grøn, Jesper, Henriksen, Tine Brink, Andreasson, Bengt, Bender, Lars, Bertelsen, Aksel, Björklund, Lars J., Dahl, Marianne, Esberg, Gitte, Eschen, Christian, Høvring, Marie, Kreft, Andreas, Kroner, Jørn, Lundberg, Fredrik, Pedersen, Pernille, Reinholdt, Jes, Stanchev, Hristo
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2013
• Subjects: Body Fluids - cytology; Chi-Square Distribution; Clinical Medicine; Continuous Positive Airway Pressure; Denmark; Drug Administration Schedule; Female; Gestational Age; Humans; Infant, Extremely Premature; Infant, Newborn; Klinisk medicin; Lamellar bodies; Lung - drug effects; Lung - physiopathology; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Nasal CPAP; Odds Ratio; Organelles; Original Paper; Oxygen Inhalation Therapy; Pediatrics; Pediatrik; Predictive Value of Tests; Premature infants; Pulmonary surfactant; Pulmonary Surfactants - administration & dosage; Respiratory distress syndrome; Respiratory Distress Syndrome, Newborn - diagnosis; Respiratory Distress Syndrome, Newborn - drug therapy; Respiratory Distress Syndrome, Newborn - mortality; Respiratory Distress Syndrome, Newborn - physiopathology; Suction; Time Factors; Treatment Outcome; Denmark; Nasal CPAP; Premature infants; Respiratory distress syndrome; Pulmonary surfactant; Continuous positive airway pressure; Lamellar bodies
• ISSN: 1661-7800; 1661-7819; 1661-7819
• DOI: 10.1159/000351638

Background: We have developed a rapid method, based on lamellar body counts (LBC) on gastric aspirate, for identifying newborns who will develop respiratory distress syndrome with a need for surfactant supplementation. Objective: We set out to test whether it was possible to improve the outcome when used in a clinical trial. Methods: We randomly assigned 380 infants born at 24-29 weeks' gestation and supported with nasal continuous positive airway pressure (nCPAP) to receive surfactant guided either by LBC (intervention group) or increasing need for oxygen (control group). The primary outcome was mechanical ventilation or death within 5 days. Secondary outcomes included need for oxygen expressed by arterial to alveolar oxygen tension ratio (a/APO 2 ) at the age of 6 h and need for oxygen at day 28. Results: The primary outcomes were equal (25%) in the two groups. The intervention group had higher a/APO 2 than the control group at 6 h, median 0.64 versus 0.52 (p < 0.01), and the subgroup with gestational age 26-29 weeks needed fewer days of oxygen supplementation than the controls, median 2 vs. 9 days (p = 0.01), and fewer infants needed oxygen at day 28 (p = 0.04). Furthermore, there was a tendency in the intervention group towards a shorter duration of nCPAP. Too little or viscose aspirate in 23% of the cases was a limitation of the method. Conclusion: Using LBC test as indicator of lung maturity and early surfactant therapy in very preterm newborns, it is possible to reduce the need for oxygen supplementation.