Laryngeal Mask Airway for Surfactant Administration in Neonates: A Randomized, Controlled Trial

Kari D. Roberts, Roland Brown, Andrea L. Lampland, Tina A. Leone, Kyle D. Rudser, Neil N. Finer, Wade D. Rich, T. Allen Merritt, Adam J. Czynski, Julie M. Kessel, Sajani M. Tipnis, Erin C. Stepka, Mark C. Mammel

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Objective: To determine if preterm infants with moderate respiratory distress syndrome on continuous positive airway pressure (CPAP) who received surfactant via a laryngeal mask airway (LMA) would have a decreased rate of intubation and mechanical ventilation compared with those on CPAP who did not receive surfactant. Study design: In this prospective, multicenter, randomized controlled trial, 103 premature infants 28 0/7 -35 6/7 weeks gestation, ≥1250 g and ≤36 hours old on CPAP requiring fraction of inspired oxygen 0.30-0.40 were assigned to receive surfactant administered through an LMA then placed back on CPAP (LMA group) or maintained on CPAP with no surfactant administered (control group). The primary outcome was treatment failure necessitating intubation and mechanical ventilation in the first 7 days of life. Results: Surfactant administration through an LMA (n = 50) significantly decreased the rate of intubation and mechanical ventilation compared with controls (n = 53): 38% vs 64%, respectively, OR 0.30 (95% CI 0.13, 0.70), P =.006, number needed to treat: 4). There were no serious adverse events associated with placement of the LMA or surfactant administration. Conclusions: In premature neonates with moderate respiratory distress syndrome, surfactant administered through an LMA decreased the rate of intubation and mechanical ventilation. This intervention may have significant impact on clinical care in both high and low resource settings. Trial registration: ClinicalTrials.gov: NCT01116921.

Original languageEnglish (US)
Pages (from-to)40-46.e1
JournalJournal of Pediatrics
Volume193
DOIs
StatePublished - Feb 2018

Bibliographical note

Funding Information:
Supported by grants from the Minnesota Medical Foundation, Children's Hospital Association , supporting Children's Minnesota, and the Clinical and Translational Sciences Institute (University of Minnesota NCATS award UL1TR000114 ). Support for Curosurf provided by Chiesi USA, Inc , support for LMAs provided by LMA North America , support for PediCaps provided by Covidien , and support for Neo-Verso Fluid/Access Catheters provided by CareFusion . The authors declare no conflicts of interest.

Funding Information:
Supported by grants from the Minnesota Medical Foundation, Children's Hospital Association, supporting Children's Minnesota, and the Clinical and Translational Sciences Institute (University of Minnesota NCATS award UL1TR000114). Support for Curosurf provided by Chiesi USA, Inc, support for LMAs provided by LMA North America, support for PediCaps provided by Covidien, and support for Neo-Verso Fluid/Access Catheters provided by CareFusion. The authors declare no conflicts of interest.

Publisher Copyright:
© 2017 Elsevier Inc.

Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.

Keywords

  • infant
  • intubation
  • preterm
  • respiratory distress syndrome

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