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The role of surfactant and non-invasive mechanical ventilation in early management of respiratory distress syndrome in premature infants
Narayan Prabhu Iyer, Maroun Jean Mhanna
Cleveland, Ohio, USA
Author Affiliations: Department of Pediatrics, Division of Neonatology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio 44109, USA (Iyer NP, Mhanna MJ)
Corresponding Author: Maroun Jean Mhanna, MD, MPH, Department of Pediatrics, Metro Health Medical Center, 2500 Metro Health Drive, Cleveland, OH 44109, USA (Tel: 216-778-1346; Fax: 216-778-4223; Email: mmhanna@metrohealth.org)
doi: 10.1007/s12519-014-0494-9
Background: Surfactant replacement therapy has been used for few decades for the treatment of respiratory distress syndrome (RDS) and has significantly improved morbidity and mortality in premature infants. Non-invasive respiratory support has recently emerged as a strategy in the early management of RDS. In this review, we discuss the different strategies of early management of RDS.
Data sources: A literature search of PubMed database was conducted to review the subject. The quality of evidence of key clinical studies was graded according to a modified grading system of the international GRADE group.
Results: Continuous positive airway pressure (CPAP) with selective surfactant is a safe alternative to routine intubation, surfactant and mechanical ventilation in preterm infants with spontaneous breathing, and such an approach has been associated with decreased risk of death and bronchopulmonary dysplasia. There is a risk of pneumothorax when using a high pressure of CPAP (¡İ8 cm of H2O), a high partial pressure of carbon dioxide (PCO2 >75 mm of Hg), and a high fraction of inspired oxygen (FiO2 >0.6) as a threshold for intubation while on CPAP.
Conclusion: Not all preterm infants need surfactant treatment, and non-invasive respiratory support is a safe and effective approach.
World J Pediatr 2014;10(3):204-210
Key words: non-invasive mechanical ventilation;
prematurity;
respiratory distress syndrome
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