Abstract: The delivery of nebulized medications to preterm infants during Non-Invasive Ventilation\n(NIV) remains an unmet clinical need. In this regard, the effective delivery of nebulized surfactant\nhas been particularly investigated in preclinical and clinical studies. In this work, we investigated the\nfeasibility of delivering nebulized surfactant through various commercially available nasal prong\ntypes. We first performed a compendial characterization of surfactant aerosols generated by the\neFlow Neos nebulizer, customized to be used in neonates, determining the amount of surfactant\ndelivered by the device as well as the aerodynamic characteristics of surfactant aerosols. Additionally,\nwe extended the compendial characterization by testing the effect of different nasal prong types\non the estimated lung dose using a realistic Continuous Positive Airway Pressure (CPAP) circuit\nthat included a cast of the upper airways of a preterm neonate. The compendial characterization\nof surfactant aerosols delivered through different nasal prongs achieved relatively high delivered\nsurfactant doses (in the range 63â??74% of the nominal dose), with aerodynamic characteristics\ndisplaying mass median aerodynamic diameters ranging between 2.52 and 2.81 micro m. Nevertheless,\nwhen using a representative in vitro setup mimicking NIV in a clinical setting, significant differences\nwere observed in terms of the estimated lung dose accounting for up to two-fold differences (from\n10% to 20% estimated lung deposition of the nominal dose) depending on the chosen nasal prong type.\nConsidering that surfactant lung deposition rates are correlated with therapeutic efficacy, this study\npoints out the relevance of choosing the appropriate NIV interface to maximize the lung dose of\nnebulized medications.
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