OBJECTIVES: The aims of this study were to assess the efficacy and feasibility of a new, less invasive surfactant administration technique for beractant replacement using a specifically designed cannula in preterm infants born at <32 weeks of gestation and to compare short- and long-term outcomes between this approach and standard treatment, consisting of intubation, administration of surfactant and early extubation to nasal continuous positive airway pressure. METHOD: This was a single-center, prospective, open-label, non-randomized, controlled pilot study with an experimental cohort of 30 patients treated with less invasive surfactant administration and a retrospective control group comprising the 30 patients most recently treated with the standard approach. Beractant (4 ml/kg) was administered as an exogenous surfactant in both groups if patients on nasal continuous positive airway pressure during the first three days of life were in need of more than 30% FiO2. Clinicaltrials.gov: NCT02611284. RESULTS: In the group with less invasive surfactant administration, beractant was successfully administered in all patients. Thirteen patients (43.3%) in the group with less invasive surfactant administration required invasive mechanical ventilation for more than 1 hour during the first 3 days of life, compared with 22 (73%) in the control group (p<0.036). The rate of requiring invasive mechanical ventilation for more than 48 hours was similar between the infants in the two groups (46% vs. 40%, respectively). There were no differences in other outcomes. CONCLUSION: The administration of beractant (4 ml/kg) using a less invasive surfactant administration technique with a specifically designed cannula for administration is feasible. Moreover, early invasive mechanical ventilation exposure is significantly reduced by this method compared with the strategy involving intubation, surfactant administration and early extubation.

Introduction: Parenteral administration of nutrients to sustain newborns' growth represents an important therapeutic challenge. Objective: To describe parenteral nutrition (PN) practices in a tertiary hospital and evaluate postnatal growth in preterm infants. Material and methods: Observational retrospective study over 3 months. Data on infants born or admitted to the Neonatal Department and starting PN were collected. Demographics, anthropometric data, daily caloric, protein intake data and PN components used were collected. Growth velocity was characterized by the average daily weight gain and compared to intrauterine growth. Results: 68 preterm infants started PN during the study period. Most infants (65%) were born by caesarean and mean gestational age was 33 weeks. Twenty five percent of newborns did not regain birth weight. The remaining 75% regained birth weight on the 3rd day of PN and average daily weight gain was 16 g/kg/d, ranging between 12 and 22 g/kg/d. Although weight gain approximated intrauterine rate, most infants born <30 weeks gestation did not achieve median birth weight of the reference population. Early aggressive PN was administered with an average of 3, 11 and 3 g/Kg/d of proteins, carbohydrates and lipids respectively, reaching a maximum on the 4th day of 4, 18, 4 g/kg/d, respectively. Discussion: Aggressive PN is used in the hospital setting. The preterm infants reached birth weight earlier and had a greater velocity of growth than in other clinical trials and similar to intrauterine.

Introducción: La administración parenteral ae nutrientes para mantener el crecimiento en recién nacidos representa un importante reto terapéutico. Objetivo: Describir las prácticas de nutrición parenteral (NP) en un hospital de tercer nivel y evaluar el crecimiento postnatal en recién nacidos prematuros. Material y métodos: Estudio observacional retrospectivo de 3 meses de duración. Se incluyeron niños ingresados en el Servicio de Neonatología que iniciaron NP. Se recogieron datos demográficos, antropométricos, calorías diarias, ingesta de proteínas y componentes de la NP. La velocidad de crecimiento se midió mediante la media de la ganancia diaria de peso y se comparó con el crecimiento intrauterino. Resultados: 68 niños prematuros iniciaron NP durante el período de estudio. La mayoría de los niños (65%) nacieron por cesárea y la media de edad gestacional fue de 33 semanas. El 25% de los recién nacidos no recuperó el peso de nacimiento. El 75% restante recuperó el peso de nacimiento en el tercer día de NP y la media de la ganancia diaria de peso fue de 16 g/kg/d, con un rango de 12 a 22 g/kg/d. A pesar de que la ganancia de peso se acercó a la tasa intrauterina, la mayoría de los niños nacidos con menos de 30 semanas de gestación no lograron la media de la población de referencia. La NP precoz e intensiva se administró con una media de 3, 11 y 3 g/Kg/d de proteínas, hidratos de carbono y lípidos, respectivamente, alcanzando un máximo en el cuarto día de 4, 18, 4 g/kg/d, respectivamente. Discusión: La NP intensiva se utiliza en el ámbito hospitalario. Los recién nacidos prematuros alcanzaron antes el peso de nacimiento y presentaron una velocidad de crecimiento mayor que en otros estudios y similar al crecimiento intrauterino.

BACKGROUND: Ventilator injury has been implicated in the pathogenesis of bronchopulmonary dysplasia. Avoiding invasive ventilation could reduce lung injury, and early respiratory management may affect pulmonary outcomes. OBJECTIVE: To analyze the effect of initial respiratory support on survival without bronchopulmonary dysplasia at a gestational age of 36 weeks. DESIGN/METHODS: A prospective 3-year observational study. Preterm infants of <32 weeks gestational age were classified into 4 groups according to the support needed during the first 2 hours of life: room air, nasal continuous positive airway pressure, intubation/surfactant/extubation and prolonged mechanical ventilation (defined as needing mechanical ventilation for more than 2 hours). RESULTS: Of the 329 eligible patients, a total of 49% did not need intubation, and 68.4% did not require prolonged mechanical ventilation. At a gestational age of 26 weeks, there was a significant correlation between survival without bronchopulmonary dysplasia and initial respiratory support. Preterm infants requiring mechanical ventilation showed a higher risk of death and bronchopulmonary dysplasia. After controlling for gestational age, antenatal corticosteroid use, maternal preeclampsia and chorioamnionitis, the survival rate without bronchopulmonary dysplasia remained significantly lower in the mechanically ventilated group. CONCLUSIONS: In our population, the need for more than 2 hours of mechanical ventilation predicted the development of bronchopulmonary dysplasia in preterm infants with a gestational age >26 weeks (sensitivity =89.5% and specificity = 67%). The need for prolonged mechanical ventilation could be an early marker for the development of bronchopulmonary dysplasia. This finding could help identify a target population with a high risk of chronic lung disease. Future research is needed to determine other strategies to prevent bronchopulmonary dysplasia in this high-risk group of patients.