Aleksei Valer’evich Mostovoi
Yaroslavl State Medical University, Russian Federation
Presentation Title:
Effect of same dose varying concentration poractant alfa on outcomes in preterm infants under 32 weeks of gestational age
Abstract
Introduction: We proposed a hypothesis that prognosis in preterm infants may be affected by concentration of the administered surfactant preparation able to determine its viscosity and, therefore, even distribution throughout the lungs.
Aim: to assess an effect of poractant alfa (PA) administered at low (40 mg/mL) vs. standard (80 mg/mL) concentration without changing recommended dosage (200 mg/kg) on outcomes of preterm infants at gestational age (GA) under 32 weeks receiving various respiratory support.
Materials and Methods: A prospective randomized controlled multicenter study was conducted. A total of 325 infants under 32 weeks of GA in five perinatal centers were randomized. The inclusion criteria were met by 264 patients: required respiratory therapy, had indications for surfactant administration at birth/within the first 30 minutes of life, and informed parental consent. Patients were excluded if they had no indications for surfactant preparations at the age of the first 30 minutes of life, had chromosomal and genetic abnormalities, congenital malformations, early neonatal sepsis, or gross deviations from the study protocol. Two groups were formed and compared: Low concentration (LC) group – PA concentration was 40 mg/mL (n = 111) and Standard concentration (SC) group (control) – PA concentration was 80 mg/mL (n = 153). Additionally, we compared two subgroups with surfactant preparation administered by minimally invasive methods in spontaneously breathing infants (using LISA – a less invasive method of introducing surfactant through a thin catheter or endotracheal tube): subgroup LC – PA concentration was 40 mg/mL (n = 27) and subgroup SC (control) – PA concentration was 80 mg/mL (n = 34).
Results: It was found that development of pulmonary hemorrhages in LC and SC groups was significantly less common in infants who received PA at concentration of 40 mg/mL vat s. 80 mg/mL: 3.6 (4/111) % vs. 13.1 (20/153) % (p = 0.008). While comparing subgroups with minimally invasive PA administration (LISA or endotracheal tube), we found thtreatment with 40 mg/mL significantly decreased total respiratory therapy duration– 142 [70.0; 219.0] hours vs. 250 [141.0; 690.0] hours (p = 0.008), incidents of bronchopulmonary dysplasia – 4.0 (1/27) % vs. 29.0 (10/34) % (p = 0.009), length of stay in neonatal intensive care unit and hospital – 8.0 [7.5; 13.0] days vs. 14.0 [8.0; 33.75] days (p = 0.014) and 38.0 [26.5; 48.5] days vs. 50.5 [36.25; 62.5] days (p = 0.014), respectively.
Conclusion: PA administered at concentration of 40 mg/mL without changing the recommended dose did not aggravate nursing of preterm infants at GA under 32 weeks. Minimally invasive PA administration at concentration of 40 mg/mL, lowered risk of bronchopulmonary dysplasia, and when used in infants on mechanical lung ventilation, it lowered a risk of pulmonary hemorrhage. All the discussed findings require to be further assessed in large prospective, multicenter, randomized studies in large patient cohort.
Biography
Aleksei V. Mostovoi graduated from the Pediatric Medical Institute in St. Petersburg in 1996. He initially worked in the NICU of City Hospital No. 1. In 1999, he completed an internship at Oakland Children's Hospital in California, USA, and in 2000, began teaching at the postgraduate faculty. He earned his PhD in 2003. Since 2010, he served as the Head of the Department of Neonatology at the Pediatric University of St. Petersburg. Since 2014, he has been an Assistant Professor at the Institute of Postgraduate Education in Yaroslavl. From 2016 to 2022, he was the Head of the NICU at the Kaluga Perinatal Center. In 2022, he took on the role of Head of Neonatology and Intensive Care at the largest Perinatal Center in Moscow, Russia. Since 2023, he has also served as an Associate Professor of Neonatology at the Academy of Postgraduate Education in Moscow. He is currently the Chief Neonatologist of the Ministry of Health in the North Caucasus region of Russia.
Mostovoi was the first in the Russian Federation to introduce HFOV, nitric oxide inhalation, aEEG, and several modern respiratory treatment and diagnostic technologies. His main focus at present is on respiratory therapy for premature newborns.
