Surfactant therapy prior to the interhospital transport of preterm infants

The Transport of Respiratory Distress Syndrome Twin Newborns: The 27-Year-Long Experience of Gaslini Neonatal Emergency Transport Service Using Both Single and Double Ventilators

OBJECTIVE

Twin pregnancy rates have increased in the past 30 years. We describe the experience of the Neonatal Emergency Transport Service of the Gaslini Hospital, Genoa, Italy, in the transport of twin newborns.

METHODS

This was a retrospective study (1996-2021); 7,852 medical charts from the Neonatal Emergency Transport Service were reviewed. We included all twin newborns who were transported with respiratory distress syndrome in the study. We split the included patients into 2 groups (group A and group B) based on if they were simultaneously ventilated by a single ventilator or by 2 different ventilators, and then each group was split by the different types of ventilation (nasal continuous positive airway pressure or intermittent positive pressure ventilation). The pH level, base excess, O₂ saturation, Pco₂, body temperature, plasma glucose, and Transport Risk Index of Physiologic Stability score were recorded at departure and arrival.

RESULTS

One hundred thirty-six patients were included (68 pairs of twins); group A consisted of 92 newborns and group B 44 newborns. Although some significant differences were observed (statistic), none of these had real clinical significance.

CONCLUSION

Transporting respiratory distress syndrome twin newborns is challenging. Our study provided a 27-year experience in the field. Transporting twins by a single ventilator is possible, but, in our opinion, using 2 ventilators mounted on the same transport module is the best possible choice in terms of clinical performance, logistics, and cost.

Surfactant Treatment of Late Preterm Infants during Emergency Transport: A Retrospective, Observational Study

BACKGROUND

In late preterm infants born in nontertiary hospitals, the occurrence of respiratory distress syndrome requires postnatal transport. This study aimed to investigate the impact of the timing of surfactant administration in late preterm infants needing postnatal transport.

METHODS

This is a retrospective study evaluating surfactant administration in late preterm infants during emergency transports by the Eastern Veneto Neonatal Emergency Transport Service between January 2005 and December 2019. The outcome measures included short-term clinical complications, stabilization time, oxygen concentration, duration of mechanical ventilation and noninvasive respiratory support, length of hospital stay, bronchopulmonary dysplasia, intraventricular hemorrhage, and sepsis.

RESULTS

Surfactant was administered to 155/303 neonates (51.1%) at 3 different time points: at a referring hospital (50 neonates), when the transport team arrived (25 neonates), or at a referral hospital (80 neonates). Stabilization time was longer in neonates receiving surfactant by the transport team (adjusted mean difference 17 min, 95% confidence interval, 4-29 min; p = 0.01). Decrease in oxygen concentrations during the transport was larger in neonates receiving surfactant at a referring hospital (adjusted mean difference -11%, 95% confidence interval, -15 to -3%; p = 0.01). The other outcome measures were not statistically different according to the timing of surfactant administration.

CONCLUSIONS

In late preterm infants with respiratory distress needing postnatal transfer, stabilization time was longer when the first surfactant was administered by the transport team, but such delay did not affect safety and clinical outcomes.

Neonatal Respiratory Support on Transport

Respiratory support is frequently required during neonatal transport. This review identifies the various modalities of respiratory support available during neonatal transport and their appropriate clinical uses. The respiratory equipment required during neonatal transport and appropriate safety checks are also reviewed. In addition, we discuss potential respiratory emergencies and how to respond to them to decrease the risk of complications during transport and improve health outcomes.

Safety of surfactant administration before transport of premature infants

OBJECTIVE

To assess the safety of surfactant administration prior to transport of premature infants.

DESIGN/METHODS

We performed a retrospective review of 24- to 34-weeks premature infants admitted to the Newborn Intensive Care Unit (NICU) between July 1, 1999 and September 30, 2004. Outcome measures were the presence of hyperventilation (PCO2 <40 mm Hg) and/or pneumothorax on admission to the NICU. Factors associated with the presence of hyperventilation and pneumothorax were identified.

RESULTS

955 infants born at 24 to 34 weeks' gestation were admitted to the NICU during the study period. 217 (22.7%) received surfactant prior to transport within 48 hours of birth. The incidence of hyperventilation was 18.9%. Hyperventilated infants had longer transport times, lower birth weights, and lower PCO2 on blood gases obtained prior to transport. Pneumothorax occurred in six subjects (2.9%). Neonates with pneumothorax had lower APGAR scores.

CONCLUSIONS

We found the administration of surfactant prior to transport to be safe as evidenced by a low incidence of pneumothorax. Pneumothorax was more likely to occur in infants who needed significant resuscitation at birth. The incidence of hyperventilation appeared to be high and was inversely associated with birth weight.

Bronchopulmonary dysplasia. Impact of surfactant replacement therapy

Bronchopulmonary dysplasia is a major contributor to the morbidity and mortality of infants born prematurely. Surfactant replacement therapy has had a significant impact on the death rate from respiratory distress syndrome, yet the impact on bronchopulmonary dysplasia is minimal. Despite these findings, the overall incidence and severity of bronchopulmonary dysplasia are likely to decline over time as neonatal care continues to advance.