A pilot study of evaluation of semi-rigid and flexible catheters for less invasive surfactant administration in preterm infants with respiratory distress syndrome-a randomized controlled trial

Lorenz Auer-Hackenberg, Johannes Brandner, Edda Hofstätter, Patricia Stroicz, Tobias Hager, Anna Eichhorn, Sebastian Schütz, Raphael Feldner, Martin Wald, Lorenz Auer-Hackenberg, Johannes Brandner, Edda Hofstätter, Patricia Stroicz, Tobias Hager, Anna Eichhorn, Sebastian Schütz, Raphael Feldner, Martin Wald

Abstract

Background: In respiratory distress syndrome, many neonatology centers worldwide perform minimal invasive surfactant application in premature infants, using small-diameter catheters for endotracheal intubation and surfactant administration.

Methods: In this single-center, open-label, randomized-controlled trial, preterm infants requiring surfactant administration after birth, using a standardized minimal invasive protocol, were randomized to two different modes of endotracheal catheterization: Flexible charrière-4 feeding tube inserted using Magill forceps (group 1) and semi-rigid catheter (group 2). Primary outcome was duration of laryngoscopy. Secondary outcomes were complication rate (intraventricular hemorrhage, soft-tissue damage in first week of life) and vital parameters during laryngoscopy. Between 2019 and 2020, 31 infants were included in the study. Prior to in-vivo testing, laryngoscopy durations were studied on a neonatal airway mannequin in students, nurses and doctors.

Results: Mean gestational age and birth weight were 27 + 6/7 weeks and 1009 g; and 28 + 0/7 weeks and 1127 g for group 1 and 2, respectively. Length of laryngoscopy was similar in both groups (61.1 s and 64.9 s) overall (p.77) and adjusted for weight (p.70) or gestational age (p.95). Laryngoscopy failed seven times in group 1 (43.8%) and four times (26.7%) in group 2 (p.46). Longer laryngoscopy was associated with lower oxygen saturation with lowest levels occurring after failed laryngoscopy attempts. Secondary outcomes were similar in both groups. In vitro data on 40 students, 40 nurses and 12 neonatologists showed significant faster laryngoscopy in students and nurses group 2 (p < .0001) unlike in neonatologists (p.13).

Conclusion: This study showed no difference in laryngoscopy duration in endotracheal catheterization when comparing semi-rigid and flexible catheters for minimal invasive surfactant application in preterm infants. In accordance with preliminary data and in contrast to published in-vitro trials, experienced neonatologists were able to perform endotracheal catheterization using both semi-rigid and flexible catheters at similar rates and ease, in vitro and in vivo.

Trial registration: ClinicalTrials.gov. NCT05024435 Registered 27 August 2021-Retrospectively registered.

Keywords: Less Invasive Surfactant Application; Minimal Invasive Surfactant Application; Preterm Infants; Respiratory Distress Syndrome.

Conflict of interest statement

Martin Wald received fees for congress talks in the last three years and sponsorship for annual respiratory care workshops by Chiesi (Chiesi Farmaceutici S.p.a. Italy). All other authors (Lorenz Auer-Hackenberg, Johannes Brandner, Tobias Hager, Anna Eichhorn, Patricia Stroicz, Edda Hofstätter, Sebastian Schütz, Raphael Feldner) have no conflicts of interest to declare.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Catheters for surfactant administration (our own photo). A Nasogastric tube (Unomedical Charrière 4; outer diameter 1.3 mm; inner diameter 0.66 mm; length 375 mm flexible REF 12,021,182, ConvaTec UK) and magill forceps. B LISAcath® (1.7 × 130 mm REF 145,872–01 Chiesi Farmaceutici S.p.a. Italy) slightly bent to facilitate intubation
Fig. 2
Fig. 2
lowest oxygen saturation during laryngoscopy. ** p (.0030)

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