Lung Recruitment Before Surfactant Administration in Extremely Preterm Neonates
Authors: Francesca Gallini, Domenico Umberto De Rose, Roberta Iuliano, Domenico Marco Romeo, Milena Tana, Angela Paladini, Francesca Paola Fusco, Stefano Nobile, Francesco Cota, Chiara Tirone, Claudia Aurilia, Alessandra Lio, Alice Esposito, Simonetta Costa, Vito D’Andrea, Maria Luisa Ventura, Virgilio Carnielli, Carlo Dani, Fabio Mosca, Monica Fumagalli, Gianfranco Scarpelli, Lucio Giordano, Valeria Fasolato, Flavia Petrillo, Pasqua Betta, Agostina Solinas, Eloisa Gitto, Giancarlo Gargano, Giovanna Mescoli, Stefano Martinelli, Sandra Di Fabio, Italo Bernardo, Lucia Gabriella Tina, Alex Staffler, Ilaria Stasi, Isabella Mondello, Eleonora Scapillati, Stefania Vedovato, Gianfranco Maffei, Adriano Bove, Marcello Vitaliti, Gianluca Terrin, Paola Lago, Camilla Gizzi, Chiara Strozzi, Paolo Ernesto Villani, Alberto Berardi, Caterina Cacace, Giorgio Bracaglia, Eleonora Pascucci, Filip Cools, Jane J. Pillow, Graeme Polglase, Roberta Pastorino, Anton H. van Kaam, Eugenio Mercuri, Luigi Orfeo, Giovanni Vento, Silvia Malguzzi, Camilla Rigotti, Alessandra Cecchi, Gabriella Nigro, Carmine Deni Costabile, Enza Roma, Paola Sindico, Rita Venafra, Carmine Mattia, Maria Conversano, Elisa Ballardini, Alessandro Manganaro, Eleonora Balestri, Claudio Gallo, Piero Catenazzi, Maria Graziana Astori, Eugenia Maranella, Carolina Grassia, Kim Maiolo, Danilo Castellano, Luca Massenzi, Elisabetta Chiodin, Maria Rita Gallina, Chiara Consigli, Elena Sorrentino, Silvia Bonato, Monica Mancini, Roberto Perniola, Silvia Giannuzzo, Elisa Tranchina, Viviana Cardilli, Lucia Dito, Daniela Regoli, Francesca Tormena, Nadia Battajon, Roberta Arena, Benedetta Allais, Isotta Guidotti, Federica Roversi, Valerio Meli, Viviana Tulino, Alessandra Casati
Journal: JAMA Network Open (2024)

Importance A multicenter randomized clinical trial (RCT) showed a lung recruitment maneuver using high-frequency oscillatory ventilation just before surfactant administration (ie, intubate-recruit-surfactant-extubate [IN-REC-SUR-E]) improved the efficacy of treatment compared with the standard intubate-surfactant-extubate (IN-SUR-E) technique without increasing the risk of adverse neonatal outcomes. Objective To examine follow-up outcomes at corrected postnatal age (cPNA) 2 years of preterm infants previously enrolled in an RCT and treated with IN-REC-SUR-E or IN-SUR-E in 35 tertiary neonatal intensive care units. Design, Setting, and Participants This was a follow-up study of infants recruited into the primary RCT from 2015 to 2018 at 35 tertiary neonatal intensive care units (NICUs) in Italy. Follow-up examinations included neurodevelopmental, growth, and respiratory outcomes of these children at cPNA 2 years. Participants included spontaneously breathing extremely preterm neonates (24 0/7 to 27 6/7 weeks’ gestation) reaching failure criteria for continuous positive airway pressure within the first 24 hours of life. Data were analyzed from April 2023 to January 2024. Intervention Infants were randomly assigned (1:1) to IN-REC-SUR-E or IN-SUR-E and then followed up. Main Outcomes and Measures The primary outcome was the occurrence of death after discharge or major disability at cPNA 2 years. Secondary outcomes were neurodevelopmental outcomes (major disability, cerebral palsy, cognitive impairment, visual deficit, or auditory deficit), anthropometric measurements (weight, length, and head circumference), and recurrent respiratory infections and hospitalizations because of respiratory causes at 2y cPNA. Results A total of 137 extremely preterm infants (median [IQR] gestational age, 26.5 [25.3-27.5] weeks and 75 [54.7%] female), initially enrolled in the original RCT, were followed up at cPNA 2 years, including 64 infants in the IN-SUR-E group and 73 infants in the IN-REC-SUR-E group. There were no significant differences in the occurrence of death after discharge or major disability at cPNA 2 years (IN-SUR-E: 13 children [20.3%] vs IN-REC-SUR-E: 10 children [13.7%]; P = .36). There were no significant differences in incidence of disability, cerebral palsy, or cognitive impairment in the IN-REC-SUR-E group compared with the IN-SUR-E group. There were no significant differences in anthropometric measurements (weight, length, and head circumference) between groups. There were no significant differences in the incidence of recurrent respiratory infections or in hospitalizations because of respiratory causes between groups. Conclusions and Relevance In this RCT of lung recruitment before surfactant vs standard care there were no significant differences between the 2 groups in death, neurodevelopmental outcomes, anthropometric measurements, or recurrent respiratory infections at the 2-year follow-up. These findings can aid clinicians in decision-making for the best strategy to administer surfactant, considering long-term outcomes.