Korean J Perinatol.  2015 Dec;26(4):289-298. 10.14734/kjp.2015.26.4.289.

Minimally Invasive Surfactant Therapy

• Shim GH

• KMID: 2164183
• DOI: http://doi.org/10.14734/kjp.2015.26.4.289

Abstract

For many years preterm infants with respiratory distress syndrome have been managed with a combination of intubation and surfactant replacement therapy. It is now recognized that applying noninvasive ventilation (NIV) such as nasal continuous positive airway pressure (CPAP) in preterm infants is a reasonable alternative to early intubation after birth. Recently, nasal CPAP has shown a benefit with a small reduction in the risk of the combined outcome of death or bronchopulmonary dysplasia. There has been an upsurge in the use of NIV as primary therapy for preterm infants, bringing with it the dilemma of when and how to give exogenous surfactant. In an effort to overcome this problem, minimally invasive surfactant therapy (MIST) to spontaneously breathing infants, allows them to remain on CPAP in first days after birth. MIST has included administration of exogenous surfactant by brief tracheal catheterization, aerosolization, laryngeal mask, and intrapharyngeal instillation. In recent clinical trials, surfactant delivery via brief tracheal catheterization was found to reduce the need for subsequent intubation and mechanical ventilation and to improve short-term respiratory outcomes. In conclusion, MIST is gentle, safe, feasible and effective to perform in preterm infants and will also be used commonly in Korea.

Keyword

Respiratory distress syndrome; Surfactant; Noninvasive ventilation; Minimally invasive surfactant therapy; Tracheal catheterization

MeSH Terms

Bronchopulmonary Dysplasia
Catheterization
Catheters
Continuous Positive Airway Pressure
Humans
Infant
Infant, Newborn
Infant, Premature
Intubation
Korea
Laryngeal Masks
Noninvasive Ventilation
Parturition
Respiration
Respiration, Artificial