Trial of aerosolised surfactant for preterm infants with respiratory distress syndrome

Objective: To evaluate the safety of an aerosolised surfactant, SF-RI 1, administered via nasal continuous positive airway pressure (nCPAP) and a prototype breath synchronisation device (AeroFact), to preterm infants with respiratory distress syndrome (RDS).

Design: Multicentre, open-label, dose-escalation study with historical controls.

Setting: Newborn intensive care units at Mater Mothers' Hospital, Brisbane, and Royal Hospital for Women, Sydney, Australia.

Patients: Infants 26 weeks through 30 weeks gestation who required nCPAP 6-8 cmH₂O and fraction of inspired oxygen (FiO₂) <0.30 at <2 hours of age.

Interventions: In part 1, infants received a single dose of 216 mg/kg of aerosolised surfactant. In part 2, infants could receive up to four doses of aerosolised surfactant. Three historical control infants were matched for each enrolled infant.

Main outcome measures: Treatment failure was defined as Respiratory Severity Score (FiO₂×cmH₂O nCPAP) >2.4, nCPAP >8 cmH₂O, arterial carbon dioxide >65 mm Hg, pH <7.20 or three severe apnoeas within 6 hours during the first 72 hours of life. Other outcomes included tolerance of the AeroFact treatment and complications of prematurity.

Results: 10 infants were enrolled in part 1 and 21 in part 2 and were compared with 93 historical controls. No safety issues were identified. In part 2, 6 of 21 (29%) AeroFact-treated infants compared with 30 of 63 (48%) control infants met failure criteria. Kaplan-Meier analysis of patients in part 2 showed a trend towards decreased rate of study failure in the AeroFact-treated infants compared with historical controls (p=0.10).

Conclusion: The AeroFact system can safely deliver aerosolised surfactant to preterm infants with RDS who are on nCPAP.

Trial registration number: ACTRN12617001458325.