658 - A Single-Center Experience with Aerosolized Calfactant in the Treatment of Respiratory Distress Syndrome

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 658
Publication Number: 658.442

Stephen minton, University of Utah, Provo, UT, United States; Erick Gerday, Intermountain Healthcare/University of Utah, Provo, UT, United States; Timothy M. Bahr, Intermountain Healthcare/University of Utah, Salt Lake City, UT, United States; Susan R. Christensen, Intermountain Healthcare, Provo, UT, United States; Jennifer 0. Elmont, Intermountain Healthcare, Provo, UT, United States

Presenting Author(s)

Stephen Minton, MD (he/him/his)

Medical Director Neonatal Critical Care TeleHealth
Intermountain Health
Provo, Utah, United States

Background: Exogenous surfactant has become a core intervention for respiratory distress syndrome in the neonate. Administration by endotracheal tube intubation has multiple risks. Alternate routes for administration, including less-invasive surfactant administration (LISA), or laryngeal mask airway (LMA), still require airway manipulation. Aerosolized surfactant is the least invasive administrative route studied.

Objective: To evaluate safety and efficacy of aerosolized surfactant to prevent the need for intubation and endotracheal surfactant in neonates with respiratory distress syndrome (RDS).

Design/Methods: We analyzed our single-center experience with aerosolized surfactant (calfactant) from both the “Comparison of Aerosol Delivery of Infasurf to Usual Care in Spontaneously Breathing RDS Patients” randomized clinical trial (AERO-02; NCT03058666) and the ongoing AERO-03 expanded-access implementation study; both after informed consent. Neonates included in this analysis were those who received early lung recruitment (1-12 hours of life), had suspected mild to moderate RDS, were on either nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive pressure ventilation (NIPPV). Each neonate received aerosolized calfactant at 6 ml/kg (210 mg phospholipids) delivered by a modified Solarys nebulized pacifier.

Results: Between 2017 and 2022, we administered aerosolized calfactant to 177 neonates. Twenty-four neonates (13.6%) required rescue intubation, surfactant via endotracheal tube, and mechanical ventilation. In infants < 29 weeks gestation, 2/4 (50%); between 29 to 33 6/7 weeks gestation, 37/45 (82.2 %); and infants ≥ 34 weeks, 114/128 (89.1%) never required rescue intubation. Because we use generous NCPAP of 8-10 cmH2O, we reviewed all chest x-rays for air leak. There were ten cases of pneumomediastinum and three cases of pneumothorax.

Conclusion(s): Our cohort of 177 neonates on NCPAP or NIPPV receiving aerosolized calfactant is the largest single-center experience reported. Aerosolized calfactant is a safe and effective treatment of RDS. Earlier institution of aerosolized calfactant appears to have best results.