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

Verder, Henrik ; Ebbesen, Finn ; Fenger-Gron, Jesper ; Henriksen, Tine Brink ; Andreasson, Bengt ; Bender, Lars ; Bertelsen, Aksel ; Björklund, Lars LU ; Dahl, Marianne and Esberg, Gitte , et al. (2013) In Neonatology 104(2). p.116-122
Abstract
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... (More)
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. Copyright (C) 2013 S. Karger AG, Basel (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Continuous positive airway pressure, Nasal CPAP, Premature infants, Respiratory distress syndrome, Pulmonary surfactant, Lamellar bodies
in
Neonatology
volume
104
issue
2
pages
116 - 122
publisher
Karger
external identifiers
  • wos:000322733700007
  • scopus:84882300700
  • pmid:23942627
ISSN
1661-7800
DOI
10.1159/000351638
language
English
LU publication?
yes
id
41db50e3-4cf4-411b-9ffc-d794e4b75f62 (old id 4042620)
date added to LUP
2016-04-01 10:16:38
date last changed
2022-02-17 08:32:50
@article{41db50e3-4cf4-411b-9ffc-d794e4b75f62,
  abstract     = {{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 &lt; 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. Copyright (C) 2013 S. Karger AG, Basel}},
  author       = {{Verder, Henrik and Ebbesen, Finn and Fenger-Gron, Jesper and Henriksen, Tine Brink and Andreasson, Bengt and Bender, Lars and Bertelsen, Aksel and Björklund, Lars and Dahl, Marianne and Esberg, Gitte and Eschen, Christian and Hovring, Marie and Kreft, Andreas and Kroner, Jorn and Lundberg, Fredrik and Pedersen, Pernille and Reinholdt, Jes and Stanchev, Hristo}},
  issn         = {{1661-7800}},
  keywords     = {{Continuous positive airway pressure; Nasal CPAP; Premature infants; Respiratory distress syndrome; Pulmonary surfactant; Lamellar bodies}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{116--122}},
  publisher    = {{Karger}},
  series       = {{Neonatology}},
  title        = {{Early Surfactant Guided by Lamellar Body Counts on Gastric Aspirate in Very Preterm Infants}},
  url          = {{http://dx.doi.org/10.1159/000351638}},
  doi          = {{10.1159/000351638}},
  volume       = {{104}},
  year         = {{2013}},
}