LARGE VOLUME SURFACTANT ADMINISTRATION IN PREMATURE INFANTS LESS THAN 35 WEEKS USING MINIMALLY INVASIVE SURFACTANT THERAPY
Bibliographic record
Abstract
A bstract Large volume surfactant administration in premature infants less than 35 weeks using minimally invasive surfactant therapy (MIST). Background Surfactant in small volume preparations can be successfully administered to premature infants using a narrow-bore vascular catheter inserted into the trachea under direct vision. It was not known if surfactant in large volume preparations could be administered effectively to spontaneously breathing premature infants while maintaining them on nasal continuous positive airway pressure (nCPAP). Objective To evaluate the feasibility of administering a large volume of surfactant (5 ml/kg) in spontaneously breathing premature infants on nCPAP using a vascular catheter. Methods Single-arm interventional trial in two level III nurseries in Canada. Spontaneously breathing premature infants between 24 and 34 weeks’ gestation, born between July 4 th , 2012 and September 5 th , 2012 were eligible for the trial in the first 24 hours of life. A 16-gauge vascular catheter was inserted under direct vision through the vocal cords to administer 5 ml/kg of surfactant while maintaining the infants on nCPAP. Results Twenty-one premature infants were enrolled. The mean gestational age was 29 ± 3 (range 24 to 34 weeks) with mean birth weight of 1474 ± 575 g. Surfactant was successfully administered in 20 infants (95 %). There was a clear effect after surfactant administration with a decrease in oxygen requirement from 0.34 ± 0.111 before the procedure, to 0.26 ± 0.08 after the procedure (p = .001), and a decrease in nCPAP pressure from 7.2 ± 0.5 cm H 2 O before the procedure to 5.9 ± 0.5 after the procedure (p < .0001). The mean duration for surfactant administration was 8.3 ± 3.4 minutes. The procedure was temporarily stopped in three cases due to bradycardia and/or apnea with desaturations that spontaneously recovered without intervention. Coughing and reflux of the surfactant were transiently observed in four cases (19 %). Conclusion It is feasible to administer large volumes of surfactant without interrupting nCPAP via a vascular catheter, to premature infants less than 35 weeks’ gestation. Further trials are needed to confirm the safety and efficacy of this method compared to other methods of surfactant administration.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".