Reintubation and risk of morbidity and mortality in preterm infants after surfactant replacement therapy

Article type: Research Article

Authors: Guardia, C.G.^; | Moya, F.R. | Sinha, S. | Gadzinowski, J. | Donn, S.M. | Simmons, P. | Segal, R.

Affiliations: Centro de Investigación Perinatal, Universidad de Chile, Santiago, Chile | South East Area Health Education Center, Department of Neonatology, Wilmington, NC, USA | James Cook University Hospital, Middlesbrough, UK | University of Medical Sciences, Poznan, Poland, and Polish Mother's Memorial Hospital Research Institute, Lodz, Poland | Division of Neonatal-Perinatal Medicine, University of Michigan Health System, Ann Arbor, MI, USA | Discovery Laboratories, Inc., Warrington, PA, USA

Note: [] Corresponding author: Fernando R. Moya, Coastal Carolina Neonatology, PLLC, 2131 South 17th Street, Wilmington, NC 28401, USA. Tel.: +1 910 667 2724; Fax: +1 910 667 7390; E-mail: [email protected]

Abstract: Background: In preterm infants at risk for RDS, reintubation following surfactant replacement therapy and successful extubation may be associated with poor clinical outcomes. Methods: Initial extubation, reintubation, mortality, and major morbidity rates associated with prematurity from two surfactant trials utilizing lucinactant, colfosceril palmitate, beractant, and poractant alfa were compared for reintubated infants versus infants who were not reintubated, and among treatment groups. Results: Initial extubation rates were similar among surfactant treatments in both trials (80–84%; p = ns). Reintubated infants had significantly higher mortality rates versus infants who were successfully extubated and never reintubated (18% vs. 0.5% respectively; OR 42 [CI 15.1–114]). Reintubated infants also had higher rates of BPD (OR 8.2; CI 5.8–11.5), air leak (3.0; 2.1–4.5), sepsis (3.6; 2.6–4.9), NEC (2.6; 1.8–3.7), IVH (3.3; 2.4–4.5), and PVL (1.8; 1.1–2.8). Reintubation rates were lower (p < 0.05) and combined outcomes of survival without reintubation were higher for infants treated with lucinactant versus beractant or poractant alfa (p < 0.05). Conclusions: Reintubation following surfactant therapy and extubation in preterm infants at risk of RDS is associated with higher morbidity and mortality. There appear to be differences in reintubation rates and survival without reintubation between surfactant preparations, with no differences in other complications of prematurity.

Keywords: Respiratory distress syndrome, surfactant, lucinactant, reintubation, mortality

DOI: 10.3233/NPM-2011-2736

Journal: Journal of Neonatal-Perinatal Medicine, vol. 4, no. 2, pp. 101-109, 2011