Prophylactic Oropharyngeal Surfactant at birth fails to reduce Intubation Rates among preterm newborns

A recent study published in Journal of American Medical Association suggests that administration of prophylactic oropharyngeal surfactant to newborns born before 29 weeks of gestational age does not reduce the need for intubation during the critical first 120 hours of life.

This clinical trial included 251 newborns born before 29 weeks of gestation without severe congenital anomalies. This study from December 2017 to September 2020 was conducted in Prophylactic Oropharyngeal Surfactant for Preterm Infants (POPART) trial across nine tertiary NICU. The infants were either assigned to receive oropharyngeal surfactant at birth in addition to continuous positive airway pressure (CPAP) or CPAP alone. The primary outcome measured was the need for intubation within 120 hours of birth due to bradycardia, apnea, or respiratory failure.

The outcomes found that, among the participants, the rate of intubation within the specified time frame did not significantly differ between the oropharyngeal surfactant group and the control group. 

63.5% of infants in the oropharyngeal surfactant group and 64.8% in the control group required intubation (relative risk, 0.98 [95% CI, 0.81-1.18]).

However, this study indicate that more newborns in the oropharyngeal surfactant group were diagnosed with and treated for pneumothorax compared to the control group (16.6% vs. 6.4%, P = .04).

The randomized clinical trial concluded that the prophylactic administration of oropharyngeal surfactant to newborns born before 29 weeks of gestation did not result in a reduced rate of intubation in the first 120 hours of life. These findings challenge the routine use of surfactant administration into the oropharynx immediately after birth in addition to CPAP for preterm infants and this prompts a reevaluation of existing protocols in neonatal intensive care units.

Reference:

Murphy, M. C., Miletin, J., Klingenberg, C., Guthe, H. J., Rigo, V., Plavka, R., Bohlin, K., Barroso Pereira, A., Juren, T., Alih, E., Galligan, M., & O’Donnell, C. P. F. (2023). Prophylactic Oropharyngeal Surfactant for preterm newborns at birth: A randomized clinical trial. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2023.5082