{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:25:35Z","timestamp":1790101535901,"version":"4.0.1"},"reference-count":40,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11,1]]},"abstract":"<jats:sec><jats:title\/><\/jats:sec><jats:sec><jats:title>BACKGROUND:<\/jats:title><jats:p>Exogenous surfactants to treat respiratory distress syndrome (RDS) are approved for tracheal instillation only; this requires intubation, often followed by positive pressure ventilation to promote distribution. Aerosol delivery offers a safer alternative, but clinical studies have had mixed results. We hypothesized that efficient aerosolization of a surfactant with low viscosity, early in the course of RDS, could reduce the need for intubation and instillation of liquid surfactant.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>A prospective, multicenter, randomized, unblinded comparison trial of aerosolized calfactant (Infasurf) in newborns with signs of RDS that required noninvasive respiratory support. Calfactant was aerosolized by using a Solarys nebulizer modified with a pacifier adapter; 6 mL\/kg (210 mg phospholipid\/kg body weight) were delivered directly into the mouth. Infants in the aerosol group received up to 3 treatments, at least 4 hours apart. Infants in the control group received usual care, determined by providers. Infants were intubated and given instilled surfactant for persistent or worsening respiratory distress, at their providers\u2019 discretion.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>Among 22 NICUs, 457 infants were enrolled; gestation 23 to 41 (median 33) weeks and birth weight 595 to 4802 (median 1960) grams. In total, 230 infants were randomly assigned to aerosol; 225 received 334 treatments, starting at a median of 5 hours. The rates of intubation for surfactant instillation were 26% in the aerosol group and 50% in the usual care group (P &amp;lt; .0001). Respiratory outcomes up to 28 days of age were no different.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>In newborns with early, mild to moderate respiratory distress, aerosolized calfactant at a dose of 210 mg phospholipid\/kg body weight reduced intubation and surfactant instillation by nearly one-half.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2019-3967","type":"journal-article","created":{"date-parts":[[2020,10,15]],"date-time":"2020-10-15T12:25:22Z","timestamp":1602764722000},"source":"Crossref","is-referenced-by-count":77,"title":["Aerosolized Calfactant for Newborns With Respiratory Distress: A Randomized Trial"],"prefix":"10.1542","volume":"146","author":[{"given":"James J.","family":"Cummings","sequence":"first","affiliation":[{"name":"Albany Medical Center, Albany, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erick","family":"Gerday","sequence":"additional","affiliation":[{"name":"Utah Valley Regional Medical Center, Provo, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Minton","sequence":"additional","affiliation":[{"name":"Utah Valley Regional Medical Center, Provo, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anup","family":"Katheria","sequence":"additional","affiliation":[{"name":"Sharp Mary Birch Hospital for Women and Newborns, San Diego, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Albert","sequence":"additional","affiliation":[{"name":"Sisters of Charity Hospital, Buffalo, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Flores-Torres","sequence":"additional","affiliation":[{"name":"Tampa General Hospital, Tampa, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mobolaji","family":"Famuyide","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Mississippi, Oxford, Mississippi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Lampland","sequence":"additional","affiliation":[{"name":"Children\u2019s Minnesota St. Paul Hospital, St. Paul, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Guthrie","sequence":"additional","affiliation":[{"name":"Jackson-Madison County General Hospital, Jackson, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devon","family":"Kuehn","sequence":"additional","affiliation":[{"name":"East Carolina University and Vidant Medical Center, Greenville, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rn-Hendrik","family":"Weitkamp","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prem","family":"Fort","sequence":"additional","affiliation":[{"name":"Johns Hopkins All Children\u2019s Hospital, St. Petersburg, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elie G.","family":"Abu Jawdeh","sequence":"additional","affiliation":[{"name":"University of Kentucky Children\u2019s Hospital, Lexington, Kentucky;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita M.","family":"Ryan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory C.","family":"Martin","sequence":"additional","affiliation":[{"name":"Phoenix Children\u2019s Hospital, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan R.","family":"Swanson","sequence":"additional","affiliation":[{"name":"University of Virginia Children\u2019s Hospital, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Mulrooney","sequence":"additional","affiliation":[{"name":"Children\u2019s Minneapolis Hospital, Minneapolis, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabien","family":"Eyal","sequence":"additional","affiliation":[{"name":"University of South Alabama Children\u2019s and Women\u2019s Hospital, Mobile, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dale","family":"Gerstmann","sequence":"additional","affiliation":[{"name":"Timpanogos Regional Hospital, Orem, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen","family":"Kumar","sequence":"additional","affiliation":[{"name":"Order of St. Francis Children\u2019s Hospital of Illinois, Peoria, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg E.","family":"Wilding","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University at Buffalo, Buffalo, New York; 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