News Reader.info

ABSTRACT OBJECTIVE: To evaluate the feasibility and safety of administering surfactant into the nasopharynx during delivery, thus permitting the baby to aspirate the solution into the

fluid-filled airway as an air–fluid interface is established. This process avoids the endotracheal intubation (ETI) and positive pressure ventilation (PPV) usually associated with

prophylaxis, thus avoiding the pulmonary barotrauma associated with the conventional method of surfactant administration. STUDY DESIGN: In all, 23 neonates weighing 560 to 1804 g and born at

27 to 30 weeks had their nasopharyngeal airways suctioned and then 3.0–4.5 ml Infasurf® instilled into the nasopharynx before delivery of the shoulders. Continuous positive airway pressure

(CPAP) of 10 cmH2O was administered by mask as the babies initiated breathing. Nasal CPAP at 6 cmH2O was then continued for a minimum of 48 hours. RESULTS: In all, 13 of 15 babies delivered

vaginally were weaned quickly to room air and required no further surfactant or endotracheal intubation for RDS. Five of eight babies delivered by C-section required subsequent endotracheal

intubation soon after birth and two received subsequent endotracheal tube surfactant. CONCLUSION: Nasopharyngeal surfactant instillation at birth appears to be relatively safe and simple to

accomplish, especially for vaginal births. A large randomized clinical trial will be required to determine the efficacy of this technique when compared to prophylaxis by endotracheal

intubation and to nCPAP alone. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your

institution Subscribe to this journal Receive 12 print issues and online access $259.00 per year only $21.58 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access

to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read

our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS LESS INVASIVE SURFACTANT ADMINISTRATION METHODS: WHO, WHAT AND HOW Article 22 September 2023 LESS INVASIVE

SURFACTANT ADMINISTRATION VIA INFANT FEEDING TUBE VERSUS INSURE METHOD IN PRETERM INFANTS: A RANDOMIZED CONTROL TRIAL Article Open access 19 December 2022 NON-PHARMACOLOGICAL APPROACH LESS

INVASIVE SURFACTANT ADMINISTRATION (NONA-LISA) TRIAL: PROTOCOL FOR A RANDOMISED CONTROLLED TRIAL Article Open access 11 January 2024 REFERENCES * Avery ME, Mead J . Surface properties in

relation to atelectasis and hyaline membrane disease. _Am J Dis Child_ 1959;97:517–523. CAS  Google Scholar  * Malloy M, Freeman DH . Respiratory distress syndrome mortality in the United

States. _J Perinatol_ 2000;20:414–420. Article  CAS  Google Scholar  * Bancalari E, delMoral T . Bronchopulmonary dysplasia and surfactant. _Biol Neonate_ 2001;80(Suppl 1):7–13. Article  CAS

  Google Scholar  * Jobe A, Ikegami M . Lung development and function in preterm infants in the surfactant treatment era. _Annu Rev Physiol_ 2000;62:825–846. Article  CAS  Google Scholar  *

Bjorklund LJ, Ingimarsson J, Curstedt T, et al. Manual ventilation with a few large breaths at birth compromises the therapeutic effect of subsequent surfactant replacement in immature

lambs. _Pediatr Res_ 1997;42:348–355. Article  CAS  Google Scholar  * Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK . Treatment of the idiopathic respiratory distress syndrome

with continuous positive airway pressure. _N Engl J Med_ 1971;284:1333–1340. Article  CAS  Google Scholar  * Kattwinkel J, Fleming D, Cha C, Fanaroff AA, Klaus MH . A new device for the

administration of continuous positive airway pressure by the nasal route. _Pediatrics_ 1973;52:131–134. CAS  Google Scholar  * VanMarter LJ, Allerd EN, Pagano M, et al. The Neonatology

Committee for the Developmental Epidemiology Network. Do clinical markers of barotrauma and oxygen toxicity explain interhospital variation in rates of chronic lung disease? The Neonatology

Committee for the Developmental Network. _Pediatrics_ 2000;105:1194–1201. Article  CAS  Google Scholar  * Aly HZ . Nasal prongs continuous positive airway pressure: a simple yet powerful

tool. _Pediatrics_ 2001;108:759–761. Article  CAS  Google Scholar  * DeKlerk AM, DeKlerk RK . Use of continuous positive airway pressure in preterm infants: comments and experience from New

Zealand. _Pediatrics_ 2001;108:761–762. Article  CAS  Google Scholar  * Niermeyer S, Kattwinkel J, VanReempts P, et al. Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac

Care, Part-11 Neonatal Resuscitation. _Circulation_ 2000;102(8, Suppl I):343–347 and Pediatrics 2000;106:e29. Google Scholar  * Karlberg P, Cherry RB, Escardo FB, Koch G . Respiratory

studies in newborn infants II: pulmonary ventilation and mechanics of breathing in the first minutes of life, including the onset of respiration. _Acta Paediatr_ 1962;51:121–136. Google

Scholar  * Ikegami M, Kallapur S, Michna J, Jobe AH . Lung injury and surfactant metabolism after hyperventilation of premature lambs. _Pediatr Res_ 2000;47:398–404. Article  CAS  Google

Scholar  * Berry D, Jobe A, Ikegami M . Leakage of macromolecules in ventilated and unventilated segments of preterm lamb lungs. _J Appl Physiol_ 1991;70:423–429. Article  CAS  Google

Scholar  * Robertson B, Berry D, Curstedt T, et al. Leakage of protein in the immature rabbit lung; effect of surfactant replacement. _Respir Physiol_ 1985;61:265–276. Article  CAS  Google

Scholar  * Enhorning G, Robertson B . Lung expansion in the premature rabbit fetus after tracheal deposition of surfactant. _Pediatrics_ 1972;50:58–66. CAS  PubMed  Google Scholar  *

Enhorning G, Grossman G, Robertson B . Pharyngeal deposition of surfactant in the premature rabbit fetus. _Biol Neonate_ 1973;22:126–132. Article  CAS  Google Scholar  * Michna J, Jobe AH,

Ikegami M . Positive end-expiratory pressure preserves surfactant function in preterm lambs. _Am J Respir Crit Care Med_ 1999;160:634–639. Article  CAS  Google Scholar  * Morley CJ, editor.

Ten centre trial of artificial surfactant (artificial lung expanding compound) in very premature babies. _BMJ_ 1987;294:991–996. Article  Google Scholar  * Henry MD, Rebello CM, Ikegami M,

Jobe AH, Langenback EG, Davis JM . Ultrasonic nebulized in comparison with instilled surfactant treatment in preterm lambs. _Am J Respir Crit Care Med_ 1996;154:366–375. Article  CAS  Google

Scholar  * Jobe A, Ikegami M, Jacobs H, Jones S . Surfactant and pulmonary blood flow distribution following treatment of preterm lambs with natural surfactant. _Clin Invest_

1984;73:848–856. Article  CAS  Google Scholar  * Cummings JJ, Holm BA, Nickerson PA, Ferguson WH, Egan EA . Pre- versus post-ventilatory surfactant treatment in surfactant-deficient preterm

lambs. _Reprod Fertil Dev_ 1995;7:1333–1338. Article  CAS  Google Scholar  * Kendig JW, Ryan RM, Sinkin RA, et al. Comparison of two strategies for surfactant prophylaxis in very premature

infants: a multicenter randomized trial. _Pediatrics_ 1998;101:1006–1012. Article  CAS  Google Scholar  * Verder H, Robertson B, Greisen G, et al. Surfactant therapy and nasal continuous

positive airway pressure for newborns with respiratory distress syndrome. Danish–Swedish Multicenter Study Group. _N Engl J Med_ 1994;331(16):1051–1055. Article  CAS  Google Scholar  *

Stevens TP, Blennow M, Soll RF . Early surfactant administration with brief ventilation vs selective surfactant and continued mechanical ventilation for preterm infants with or at risk for

RDS. _Cochrane Database Syst Rev_ 2002(2):CD003063. * Morley CJ . Systematic review of prophylactic vs rescue surfactant. _Arch Dis Child Fetal Neonatal Ed_ 1997;77(1):70F–74. Article 

Google Scholar  Download references AUTHOR INFORMATION Author notes * James E Ferguson MD Present address: Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY, USA

AUTHORS AND AFFILIATIONS * Department of Pediatrics, University of Virginia, VA, USA John Kattwinkel MD & Melinda Robinson RN * Department of Obstetrics, University of Virginia, VA, USA

James E Ferguson MD * Wesley Medical Center, Wichita, KS, USA Barry T Bloom MD & Paula Delmore RN Authors * John Kattwinkel MD View author publications You can also search for this

author inPubMed Google Scholar * Melinda Robinson RN View author publications You can also search for this author inPubMed Google Scholar * Barry T Bloom MD View author publications You can

also search for this author inPubMed Google Scholar * Paula Delmore RN View author publications You can also search for this author inPubMed Google Scholar * James E Ferguson MD View author

publications You can also search for this author inPubMed Google Scholar RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Kattwinkel, J., Robinson, M.,

Bloom, B. _et al._ Technique for Intrapartum Administration of Surfactant without Requirement for an Endotracheal Tube. _J Perinatol_ 24, 360–365 (2004).

https://doi.org/10.1038/sj.jp.7211103 Download citation * Published: 15 April 2004 * Issue Date: 01 June 2004 * DOI: https://doi.org/10.1038/sj.jp.7211103 SHARE THIS ARTICLE Anyone you share

the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer

Nature SharedIt content-sharing initiative