Study Finds No Long-Term Benefits of Lung Recruitment Before Surfactant in Extremely Preterm Neonates

The trial, published in JAMA Network Open, compared a group of neonates who underwent lung recruitment maneuvers before receiving surfactant to a control group that received standard care. There were no notable differences between the two groups regarding mortality, neurodevelopmental outcomes, growth measurements, or rates of recurrent respiratory infections at the two-year follow-up.

"These findings can assist clinicians in determining the most effective approach to surfactant administration by taking long-term outcomes into account," the researchers wrote.

A multicenter randomized clinical trial (RCT) demonstrated that employing a lung recruitment maneuver with high-frequency oscillatory ventilation just before surfactant administration—referred to as intubate-recruit-surfactant-extubate (IN-REC-SUR-E)—enhanced treatment efficacy compared to the standard intubate-surfactant-extubate (IN-SUR-E) method, without raising the risk of negative neonatal outcomes. Francesca Gallini, Neonatology Unit, Ospedale Isola Tiberina, Gemelli Isola, Rome, Italy, and colleagues aimed to evaluate follow-up outcomes at a corrected postnatal age (cPNA) of two years for preterm infants who were previously enrolled in an RCT and received either the IN-REC-SUR-E or IN-SUR-E treatment across 35 tertiary neonatal intensive care units.

For this purpose, the researchers conducted a follow-up study on infants recruited from 2015 to 2018 at 35 tertiary neonatal intensive care units (NICUs) in Italy. The study assessed neurodevelopmental, growth, and respiratory outcomes at a corrected postnatal age (cPNA) of two years for extremely preterm neonates (24 0/7 to 27 6/7 weeks' gestation) who met failure criteria for continuous positive airway pressure within the first 24 hours of life. Participants were randomly assigned to either the IN-REC-SUR-E or IN-SUR-E intervention.

The primary outcome measured was the incidence of death after discharge or major disability at cPNA for two years. Secondary outcomes included neurodevelopmental issues (such as major disability, cerebral palsy, cognitive impairment, and sensory deficits), anthropometric data (weight, length, and head circumference), and rates of recurrent respiratory infections and hospitalizations due to respiratory causes at two years cPNA. Data analysis occurred between April 2023 and January 2024.

Based on the study, the researchers revealed the following findings:

• One hundred thirty-seven extremely preterm infants (median gestational age, 26.5 weeks and 54.7% female), initially enrolled in the original RCT, were followed up at cPNA two 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 death occurrence after discharge or major disability at cPNA two years (IN-SUR-E: 20.3% children versus IN-REC-SUR-E: 13.7% children).
• There were no significant differences in the 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 between groups in the incidence of recurrent respiratory infections or hospitalizations because of respiratory causes.

The findings indicate that the intubate-recruit-surfactant-extubate technique is a safe approach for the outcomes assessed.

However, the researchers noted that their findings cannot yet be compared with data from other cohorts. They emphasized the need for further multicenter studies to confirm their results better.

"Additionally, neurodevelopmental outcomes, including growth and respiratory health, for all patients treated with this new procedure should be evaluated prospectively to further validate the safety and efficacy of the IN-REC-SUR-E technique compared to the standard IN-SUR-E method," they concluded.

Reference:

Gallini F, De Rose DU, Iuliano R, et al. Lung Recruitment Before Surfactant Administration in Extremely Preterm Neonates: 2-Year Follow-Up of a Randomized Clinical Trial. JAMA Netw Open. 2024;7(9):e2435347. doi:10.1001/jamanetworkopen.2024.35347