Abstract
Objective: To evaluate the stable microbubble test (SMT) ability to select candidates for surfactant prophylaxis for respiratory distress syndrome (RDS).
Study design: We followed patients treated according to a new routine for surfactant prophylaxis based on the SMT to determine timing of the initial dose of surfactant, proportion of infants using surfactant, and the predictive value of the SMT. Gastric secretions were collected after birth. Newborns with <25 microbubbles (MB)/mm2 received prophylactic surfactant. Surfactant was given only after confirmation of RDS (rescue therapy) to newborns with ≥25 MB/mm2.
Results: Fifty-four (55%) had a low MB count and received prophylactic surfactant. Three out of 44 infants with a high MB count required rescue therapy (negative predictive value 93%; CI:81.3–98.6%). The median interval and interquartile range between surfactant administration and birth in the prophylaxis group was 20 (17–27) minutes. Surfactant was used in 23 of 28 (82%) infants born at <28 weeks of gestation and in 34 of 70 (49%) infants between 28 and 31 weeks.
Conclusions: The SMT may be useful to determine surfactant prophylaxis (<30 min after birth). This approach may reduce costs and the number of unnecessary interventions.
References
1 Bjorklund LJ, J Ingimarsson, T Curstedt, J John, B Robertson, O Werner, et al.: Manual ventilation with a few large breaths at birth compromises the therapeutic effect of subsequent surfactant replacement in immature lambs. Pediatr Res42 (1997) 348Search in Google Scholar
2 Bohlin K, T Gudmundsdottir, M Katz-Salamon, B Jonsson, M Blennow: Surfactant treatment during continuous positive airway pressure – a safe alternative for moderately preterm infants [abstract]. Biol Neonate87 (2005) 354Search in Google Scholar
3 Boo NY, KB Cheong, SK Cheong, MS Lye, Zulfiqar: Usefulness of stable microbubble test of tracheal aspirate for the diagnosis of neonatal respiratory distress syndrome. J Paediatr Child Health33 (1997) 329Search in Google Scholar
4 Chida S, T Fujiwara: Stable microbubbles test for predicting the risk of respiratory distress syndrome: II. Prospective evaluation of the test on amniotic fluid and gastric aspirate. Eur J Pediatr152 (1993) 152Search in Google Scholar
5 Fiori HH, I Varela, AL Justo, RM Fiori: Stable microbubble test and click test to predict respiratory distress syndrome in preterm infants not requiring ventilation at birth. J Perinat Med31 (2003) 509Search in Google Scholar
6 Friedrich W, M Haufe, G Schmalisch, RR Wauer: The stable microbubble test on tracheal aspirate samples from newborn babies for diagnosis of surfactant deficiency and/or surfactant malfunction. Biol Neonate73 (1998) 10Search in Google Scholar
7 Horbar JD, JH Carpenter, J Buzas, RF Soll, G Suresh, MB Bracken, LC Leviton, PE Plsek, JC Sinclair: Vermont Oxford Network. Timing of initial surfactant treatment for infants 23–29 weeks' gestation: is routine practice evidence based?Pediatrics113 (2004) 1593Search in Google Scholar
8 Ikegami M, K Wada, GA Emerson, CM Rebello, RE Hernandez, AH Jobe: Effects of ventilation style on surfactant metabolism and treatment response in preterm lambs. Am J Respir Crit Care Med157 (1998) 638Search in Google Scholar
9 Jobe A, M Ikegami, H Jacobs, S Jones: Surfactant and pulmonary blood flow distributions following treatment of premature lambs with natural surfactant. J Clin Invest73 (1984) 848Search in Google Scholar
10 Jobe AH, M Ikegami: Mechanisms initiating lung injury in the preterm. Early Hum Dev53 (1998) 81Search in Google Scholar
11 Jonson B: Ventilation patterns, surfactant and lung injury. Biol Neonate71 (1997) 13Search in Google Scholar
12 Kattwinkel J, BT Bloom, P Delmore, CL Davis, E Farrell, H Friss, et al.: Prophylactic administration of calf lung surfactant extract is more effective than early treatment of respiratory distress syndrome in neonates of 29 through 32 weeks' gestation. Pediatrics92 (1993) 90Search in Google Scholar
13 Kendig JW, RM Ryan, RA Sinkin, WM Maniscalco, RH Notter, R Guillet, et al.: Comparison of two strategies for surfactant prophylaxis in very premature infants: a multicenter randomized trial. Pediatrics101 (1998) 1006Search in Google Scholar
14 Nilsson R, G Grossmann, B Robertson: Bronchiolar epithelial lesions induced in the premature rabbit neonate by short periods of artificial ventilation. Acta Pathol Microbiol Scand [A]88 (1980) 359Search in Google Scholar
15 Osborn DA, HE Jeffery, SL Bredemeyer, JM Polverino, S Reid: Targeted early rescue surfactant in ventilated preterm infants using the click test. Pediatrics106 (2000) E3010.1542/peds.106.3.e30Search in Google Scholar PubMed
16 Pattle RE, CC Kratzing, CE Parkinson, L Graves, RD Robertson, GJ Robards, et al.: Maturity of fetal lungs tested by production of stable microbubbles in amniotic fluid. Br J Obstet Gynaecol86 (1979) 615Search in Google Scholar
17 Pereira MR, HH Fiori, JH Luz, RM Fiori: Inter- and intra-observer agreement and the effect of freezing in the stable microbubble test performed in gastric aspirates of newborns [abstract]. Proceedings of the 17th International Workshop on Surfactant Replacement; 2002 May 24–26; Cagliari, ItalySearch in Google Scholar
18 Seitz EE, HH Fiori, JH Luz, RM Fiori: Stable microbubble test on tracheal aspirate for the diagnosis of respiratory distress syndrome. Biol Neonate87 (2005) 140Search in Google Scholar
19 Soll RF, CJ Morley: Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2 (2001) CD00051010.1002/14651858.CD000510Search in Google Scholar PubMed
20 Verder H, B Robertson, G Greisen, F Ebbesen, P Albertsen, K Lundstrom, T Jacobsen. Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. Danish-Swedish Multicenter Study Group. N Engl J Med331 (1994) 1051Search in Google Scholar
21 Yost CC, RF Soll: Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev 2 (2000) CD001456Search in Google Scholar
©2006 by Walter de Gruyter Berlin New York
