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ORIGINAL RESEARCH article

Front. Pediatr.
Sec. Neonatology
Volume 12 - 2024 | doi: 10.3389/fped.2024.1352784
This article is part of the Research Topic Ultra Low Birth Weight Infants (ULBWI, Birth Weight < 500 g), a New Challenge View all articles

Influence of catheter thickness on respiratory physiology during less invasive surfactant administration in extremely preterm infants

Provisionally accepted
Chamindu C. Gunatilaka Chamindu C. Gunatilaka 1,2Qiwei Xiao Qiwei Xiao 1,2Alister J. Bates Alister J. Bates 1,2,3Axel R. Franz Axel R. Franz 4,5Christian F. Poets Christian F. Poets 4Christian A. Maiwald Christian A. Maiwald 4,5*
  • 1 Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • 2 Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • 3 Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States
  • 4 Department of Neonatology, University Children's Hospital Tübingen, Tübingen, Germany
  • 5 Center for Pediatric Clinical Studies (CPCS), University Hospital Tübingen, Tübingen, Germany

The final, formatted version of the article will be published soon.

    Introduction: Delivering surfactant via thin catheters (minimal-invasive surfactant therapy (MIST); less invasive surfactant administration (LISA)) has become a common procedure.However, the effect of tracheal obstruction caused by catheters of different sizes on tracheal resistance in extremely low gestational age newborns (ELGANs) is unknown.To investigate the affect of catheters size 3.5, 5 and 6 French on airway resistance in ELGANs of 23-28 weeks gestational age during LISA, we performed calculations based on Hagen-Poiseuille's law and compared these with a clinically and physically more accurate method: computational fluid dynamics (CFD) simulations of respiratory airflow, performed in 3D virtual airway models derived from MRI.The presence of the above catheters decreased the cross-sectional area of the infants' tracheal entrance (the cricoid ring) by 13-53%. Hagen-Poiseuille's law predicted an increase in resistance by 1.5-4.5 times and 1.3-2.6 times in ELGANs born at 23 and 28 weeks, respectively. However, CFD simulations demonstrated an even higher increase in resistance of 3.4-85.1 and 1.1-3.5 times, respectively. The higher calculated resistances were due to the extremely narrow remaining lumen at the glottis and cricoid with the catheter inserted, resulting in a stronger glottal jet and turbulent airflow, which was not predicted by Hagen-Poiseuille.Catheter thickness can greatly increase tracheal resistance during LISAprocedures in ELGANs. Based on these models, it is recommended to use the thinnest catheter possible during LISA in ELGANs to avoid unnecessary increases in airway resistance in infants already experiencing dyspnea due to respiratory distress syndrome.

    Keywords: Less invasive surfactant administration (LISA), minimal invasive surfactant therapy (MIST), Respiratory Distress Syndrome, ELGANS, Respiratory Physiology

    Received: 08 Dec 2023; Accepted: 02 Sep 2024.

    Copyright: © 2024 Gunatilaka, Xiao, Bates, Franz, Poets and Maiwald. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Christian A. Maiwald, Department of Neonatology, University Children's Hospital Tübingen, Tübingen, Germany

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