BACKGROUND AND PURPOSE:

• For newborns with respiratory distress syndrome (RDS), surfactant treatment requires intubation and is often followed by positive pressure ventilation
  • Aerosol delivery would be safer, but clinical studies have been inconclusive
• Cummings et al. (Pediatrics, 2020) examined whether efficient aerosolization of a surfactant early in the course of RDS could reduce the need for intubation and instillation of liquid surfactant

METHODS:

• Prospective, multicenter, randomized, unblinded comparison trial
• Participants
  • Newborns with signs of RDS that required noninvasive respiratory support
• Interventions
  • Usual care, as determined by provider
  • Aerosolized calfactant (calf-derived surfactant)
    • Calfactant was aerosolized using a nebulizer
    • 6 mL/kg (210 mg phospholipid/kg body weight) delivered directly into the mouth
    • Infants received up to 3 treatments, at least 4 hours apart
• Study design
  • Infants were intubated and given instilled surfactant for persistent or worsening respiratory distress (clinicians’ discretion)

RESULTS:

• 457 infants | 230 infants in aerosol group 
  • Gestation: 23 to 41 (median 33) weeks
  • Birth weight: 595 to 4802 (median 1960) grams
• 225 of the infants in the aerosol group received 334 treatments, starting at median 5 hours
• Rate of intubation for surfactant instillation were significantly decreased in the aerosol group (P < 0.0001)
  • Aerosol: 26%
  • Usual care: 50%
• There was no difference in respiratory outcomes up to 28 days of age

CONCLUSION:

• Aerosolized calfactant reduced the need for intubation and surfactant instillation by nearly one-half in newborns with early, mild to moderate respiratory distress
• An accompanying editorial concludes that the results are promising and may help avoid intubation currently required for standard surfactant use
  • However, study limitations include lack of blinding and pragmatic approach that would allow for multiple different management scenarios across multiple sites

Learn More – Primary Sources:

Aerosolized Calfactant for Newborns With Respiratory Distress: A Randomized Trial

Aerosolized Calfactant in Infants With RDS: Surfactant Replacement 2.0?

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