A new minimally-invasive method of delivering surfactant is safe and could reduce the need for mechanical ventilation that can cause lung damage and result in breathing problems and chronic lung disease, according to the Avoiding Mechanical Ventilation (AMV) trial published in The Lancet.
The AMV trial was designed to test a new method of surfactant delivery without the use of an endotracheal tube or mechanical ventilation. The new technique involves giving surfactant early to spontaneously breathing premature babies on continuous positive airway pressure (CPAP) through a thin catheter inserted into the windpipe that is removed quickly, as soon as the surfactant is delivered.
CPAP is an alternative noninvasive method of ventilation that involves pushing air and/or oxygen through the nose to gently inflate the lungs while babies are breathing by themselves. Until now, a disadvantage of CPAP was that without intubation, babies had not been treated with surfactant.
Between October 2007 and January 2008, German researchers enrolled 220 premature babies—gestational age between 26 and 28 weeks—and randomly assigned them to receive either standard treatment (112 babies, rescue intubation, then surfactant if needed during mechanical ventilation) or intervention (108 babies; early administration of surfactant during spontaneous breathing).
The findings showed that on day 2 or 3 after birth, babies in the intervention group were significantly less likely to be mechanically ventilated compared with those given standard treatment—28% versus 46%—and also less likely to need mechanical ventilation during the rest of their hospital stay. Additionally, babies given the new treatment spent significantly less time on mechanical ventilation, and had a lower need for oxygen at 28 days—30% versus 45%.