AIM: Minimally aggressive and easily performed techniques that facilitate spontaneous respiratory stabilisation are required to reduce rescue intubation in extremely premature infants. This study evaluated the feasibility and safety of administering surfactant into the pharynx of infants born at <25 weeks immediately after birth. METHODS: This study of 19 infants was conducted from January 2013 to June 2014 in a tertiary perinatal centre in Prague. We administered 1.5 mL of Curosurf as a bolus into the pharynx and simultaneously performed a sustained inflation manoeuvre (SIM). The extent of the interventions, death and severe neonatal morbidity in the study group were compared with 20 controls born before the study period and 20 born after it. RESULTS: All infants received oropharyngeal surfactant within the median (interquartile range) time of 40 seconds (25-75) after cord camping. The surfactant had to be suctioned in one infant because of upper airway obstruction. Although more subsequent surfactant was administered in the study group, significantly fewer study period infants required intubation than the before and after controls (16% versus 75% and 58%, respectively, p < 0.01). CONCLUSION: Oropharyngeal surfactant with simultaneous SIM was feasible and safe and reduced the need for delivery room intubation in these fragile infants.

• MeSH
• biologické přípravky aplikace a dávkování   MeSH
• fosfolipidy aplikace a dávkování   MeSH
• intratracheální intubace využití   MeSH
• lidé MeSH
• novorozenci extrémně nezralí MeSH
• novorozenec MeSH
• plicní surfaktanty aplikace a dávkování   MeSH
• resuscitace metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky kontrolované MeSH

OBJECTIVE: To evaluate the heart rate (HR) and oxygen saturation (SpO2) at 15-second intervals within 60 seconds after incremental increases of fractional inspired oxygen (FiO2) during resuscitation of infants younger than 29 weeks requiring two different forms of ventilatory support. STUDY DESIGN: Retrospective observational study. METHODS: Forty-three infants were stabilized, 14 by continuous positive airway pressure exclusively (CPAP group), and 29 by positive pressure ventilation (PPV group). Both groups received ventilatory support in a special bed with two cameras enabling the evaluation of all interventions including HR, SpO2, FiO2, positive inflation pressure, and positive end-expiratory pressure values. FiO2 was commenced at 0.30 and titrated in 0.1-0.2 increments every 30-60 seconds. The relationships between the incremental increases of FiO2 and related SpO2 and HR changes were evaluated. RESULTS: Although there was an inverse correlation between initial FiO2 and SpO2 in both groups, a significant positive correlation between the incremental increase of FiO2 and SpO2 changes after 30 seconds was found only in the CPAP group. Only higher initial levels of FiO2 had a positive effect on the improvement in SpO2 in the PPV group. CONCLUSION: The efficacy of FiO2 titration in 0.1-0.2 increments may be attenuated and delayed in extremely preterm infants required PPV during the first 6 minutes of life.

• MeSH
• kyslík analýza   MeSH
• lidé MeSH
• novorozenci extrémně nezralí * MeSH
• novorozenec MeSH
• resuscitace metody   MeSH
• retrospektivní studie MeSH
• trvalý přetlak v dýchacích cestách MeSH
• ventilace umělá s výdechovým přetlakem MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH