Henrik Verder

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Henrik Verder
Henrik Verder.jpg
Born1942 (age 80–81)
Denmark
NationalityDanish
EducationPhD
OccupationPaediatrician
Employer(s)Holbaek University Hospital, Denmark
TitleMD

Henrik Verder (born 1942) is a pediatrician and the inventor of the INSURE (Intubation Surfactant Extubation)and LISA (Less Invasive Surfactant Administration) methods combined with nasal CPAP (Continuous Positive Airway Pressure). In 1989 he used this pioneering method to successfully treat the first premature infant with severe RDS. [1] Verder is a significant researcher within the field of paediatrics, with more than 50 publications and over 500 citations. [2]

Contents

Biography

Verder received his medical degree from Copenhagen University in 1968 and went on to specialise in paediatrics in 1978, concentrating on prenatal determination of lung maturity and prevention of RDS (Infant Respiratory Distress Syndrome). In 1980 he was awarded his medical doctorate from Copenhagen University for his thesis on “Prenatal determination of lung maturity and prevention of RDS”. [3]

Career

In 1972 Verder began his associated professorship at Copenhagen University where he went on to become a Professor of Paediatrics and Neonatology. [4] In 1989, at Holbaek Hospital, Verder was the first physician to successfully combine nasal CPAP and surfactant to treat an infant with severe RDS (28 weeks). This unique method was later named INSURE by Mats Blennow et al. [5] The full method was first published in 1992 along with the first documentation of infants treated with surfactant via a small diameter tube. [6] Egbert Herting has since described this method as ‘Less Invasive Surfactant Administration (LISA)’. [7] In addition surfactant administration via a laryngeal mask was described for the first time in 1992. [8] The introduction of CPAP in the treatment of RDS [9] more than halved the mortality rate of RDS – reducing mortality from an estimated 50% to 20%. [10] CPAP, when combined with the use of surfactant (INSURE), [11] halved the mortality rate once again, lowering it to approximately 10%. Early treatment of premature infants with RDS using the nasal CPAP and surfactant (INSURE) method is today considered the Global Gold standard of care.

Alongside his clinical achievements, Verder has also been actively involved in improving childcare and in 1975 he took the position of consultant for “Glostrup Observation Home” an institution for observation and treatment of neglected infants and toddlers. [12] In 1998 Verder began working with Professor Bo Sun at Fudan University, Shanghai, to improve neonatal care across China. As a part of this initiative he has visited more than 50 hospitals across 25 provinces and given lectures on the prevention and treatment of RDS, nutrition of pre-term and newborn infants and mother child attachment. [13] [14] [15] [16] [17] Alongside his contributions to Copenhagen University and his work in China, Verder also took the position of Co-chairman at Save the Children Denmark from 1990 to 1993. In this position, together with secretary-general Kristian Sørensen and lawyer Hanne Jensbo from Save the Children Denmark, he spearheaded the opening of Romanian orphanages after the fall of Ceaucescu in 1989. Verder was also involved in several initiatives, which supported the Romanian healthcare system. [18] [19] In 2011 Verder became a member of the steering committee of “The Family Center” directed by Dr. May Olofsson, Hvidovre University Hospital, Copenhagen. [20] An organisation that treats infants and mothers suffering from sequelae, caused by alcohol and drug addiction during pregnancy. [21]

The INSURE Method

Verder is the inventor and pioneer of the INSURE method, a very effective approach to managing preterm neonates with respiratory distress. The method itself has been shown to successfully decrease the use of mechanical ventilation and lower the incidence of bronchopulmonary dysplasia (BPD). [22] Since its inception in 1989 the INSURE method has been academically cited in more than 500 papers. [23] The first randomised study on the INSURE method was published in 1994 [24] and a second randomised study in infants less than 30 weeks gestation was published by the group in 1999. [25] In the last 15 years Verder has worked with lung maturity diagnostics on gastric aspirates obtained at birth. By combining this diagnostic method with INSURE, Verder has worked to further improve the clinical outcome of RDS. The lung maturity tests used have been the microbubble test, [26] lamellar body counts (LBC) [27] and measurements of lecithin-sphingomyelin ratio (L/S) [28] with chemometrics, involving a collaboration with Agnar Höskuldsson. [29]

Related Research Articles

<span class="mw-page-title-main">Meconium aspiration syndrome</span> Medical condition affecting newborn infants

Meconium aspiration syndrome (MAS) also known as neonatal aspiration of meconium is a medical condition affecting newborn infants. It describes the spectrum of disorders and pathophysiology of newborns born in meconium-stained amniotic fluid (MSAF) and have meconium within their lungs. Therefore, MAS has a wide range of severity depending on what conditions and complications develop after parturition. Furthermore, the pathophysiology of MAS is multifactorial and extremely complex which is why it is the leading cause of morbidity and mortality in term infants.

<span class="mw-page-title-main">Positive airway pressure</span> Mechanical ventilation in which airway pressure is always above atmospheric pressure

Positive airway pressure (PAP) is a mode of respiratory ventilation used in the treatment of sleep apnea. PAP ventilation is also commonly used for those who are critically ill in hospital with respiratory failure, in newborn infants (neonates), and for the prevention and treatment of atelectasis in patients with difficulty taking deep breaths. In these patients, PAP ventilation can prevent the need for tracheal intubation, or allow earlier extubation. Sometimes patients with neuromuscular diseases use this variety of ventilation as well. CPAP is an acronym for "continuous positive airway pressure", which was developed by Dr. George Gregory and colleagues in the neonatal intensive care unit at the University of California, San Francisco. A variation of the PAP system was developed by Professor Colin Sullivan at Royal Prince Alfred Hospital in Sydney, Australia, in 1981.

<span class="mw-page-title-main">Infant respiratory distress syndrome</span> Human disease affecting newborns

Infantile respiratory distress syndrome (IRDS), also called respiratory distress syndrome of newborn, or increasingly surfactant deficiency disorder (SDD), and previously called hyaline membrane disease (HMD), is a syndrome in premature infants caused by developmental insufficiency of pulmonary surfactant production and structural immaturity in the lungs. It can also be a consequence of neonatal infection and can result from a genetic problem with the production of surfactant-associated proteins.

Transient tachypnea of the newborn is a respiratory problem that can be seen in the newborn shortly after delivery. It is caused by retained fetal lung fluid due to impaired clearance mechanisms. It is the most common cause of respiratory distress in term neonates. It consists of a period of tachypnea (rapid breathing. Usually, this condition resolves over 24–72 hours. Treatment is supportive and may include supplemental oxygen and antibiotics. The chest x-ray shows hyperinflation of the lungs including prominent pulmonary vascular markings, flattening of the diaphragm, and fluid in the horizontal fissure of the right lung.

<span class="mw-page-title-main">Neonatal intensive care unit</span> Intensive care unit specializing in the care of ill or premature newborn infants

A neonatal intensive care unit (NICU), also known as an intensive care nursery (ICN), is an intensive care unit (ICU) specializing in the care of ill or premature newborn infants. The NICU is divided into several areas, including a critical care area for babies who require close monitoring and intervention, an intermediate care area for infants who are stable but still require specialized care, and a step down unit where babies who are ready to leave the hospital can receive additional care before being discharged.

Antenatal steroids, also known as antenatal corticosteroids, are medications administered to pregnant women expecting a preterm birth. When administered, these steroids accelerate the maturation of the fetus' lungs, which reduces the likelihood of infant respiratory distress syndrome and infant mortality. The effectiveness of this corticosteroid treatment on humans was first demonstrated in 1972 by Sir Graham Liggins and Ross Howie, during a randomized control trial using betamethasone.

<span class="mw-page-title-main">Respiratory disease</span> Disease of the respiratory system

Respiratory diseases, or lung diseases, are pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, bronchioles, alveoli, pleurae, pleural cavity, the nerves and muscles of respiration. Respiratory diseases range from mild and self-limiting, such as the common cold, influenza, and pharyngitis to life-threatening diseases such as bacterial pneumonia, pulmonary embolism, tuberculosis, acute asthma, lung cancer, and severe acute respiratory syndromes, such as COVID-19. Respiratory diseases can be classified in many different ways, including by the organ or tissue involved, by the type and pattern of associated signs and symptoms, or by the cause of the disease.

<span class="mw-page-title-main">Bronchopulmonary dysplasia</span> Medical condition

Bronchopulmonary dysplasia is a chronic lung disease in which premature infants, usually those who were treated with supplemental oxygen, require long-term oxygen. The alveoli that are present tend to not be mature enough to function normally. It is more common in infants with low birth weight (LBW) and those who receive prolonged mechanical ventilation to treat respiratory distress syndrome (RDS). It results in significant morbidity and mortality. The definition of BPD has continued to evolve primarily due to changes in the population, such as more survivors at earlier gestational ages, and improved neonatal management including surfactant, antenatal glucocorticoid therapy, and less aggressive mechanical ventilation.

<span class="mw-page-title-main">Dipalmitoylphosphatidylcholine</span> Chemical compound

Dipalmitoylphosphatidylcholine (DPPC) is a phospholipid (and a lecithin) consisting of two C16 palmitic acid groups attached to a phosphatidylcholine head-group.

<span class="mw-page-title-main">Continuous positive airway pressure</span> Form of ventilator which applies mild air pressure continuously to keep airways open

Continuous positive airway pressure (CPAP) is a form of positive airway pressure (PAP) ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person. The application of positive pressure may be intended to prevent upper airway collapse, as occurs in obstructive sleep apnea, or to reduce the work of breathing in conditions such as acute decompensated heart failure. CPAP therapy is highly effective for managing obstructive sleep apnea. Compliance and acceptance of use of CPAP therapy can be a limiting factor, with 8% of people stopping use after the first night and 50% within the first year.

<span class="mw-page-title-main">Diffuse alveolar damage</span> Medical condition

Diffuse alveolar damage (DAD) is a histologic term used to describe specific changes that occur to the structure of the lungs during injury or disease. Most often DAD is described in association with the early stages of acute respiratory distress syndrome (ARDS). It is important to note that DAD can be seen in situations other than ARDS (such as acute interstitial pneumonia) and that ARDS can occur without DAD.

Lucinactant is a liquid medication used to treat infant respiratory distress syndrome. It is a pulmonary surfactant for infants who lack enough natural surfactant in their lungs. Whereas earlier medicines of the class, such as beractant, calfactant (Infasurf), and poractant (Curosurf), are derived from animals, lucinactant is synthetic. It was approved for use in the United States by the U.S. Food and Drug Administration (FDA) on March 6, 2012.

Poractant alfa is a pulmonary surfactant sold under the brand name Curosurf by Chiesi Farmaceutici. Poractant alfa is an extract of natural porcine lung surfactant. As with other surfactants, marked improvement on oxygenation may occur within minutes of the administration of poractant alfa. The new generic form of surfactant is Varasurf developed in PersisGen Co. and commercialized by ArnaGen Pharmad. It has fully comparable quality profile with Curosurf.

<span class="mw-page-title-main">Heated humidified high-flow therapy</span> Respiratory support method

Heated humidified high-flow therapy, often simply called high flow therapy, is a type of respiratory support that delivers a flow of medical gas to a patient of up to 60 liters per minute and 100% oxygen through a large bore or high flow nasal cannula. Primarily studied in neonates, it has also been found effective in some adults to treat hypoxemia and work of breathing issues. The key components of it are a gas blender, heated humidifier, heated circuit, and cannula.

Beractant, also known by the trade name of Survanta, is a modified bovine pulmonary surfactant containing bovine lung extract, to which synthetic DPPC, tripalmitin and palmitic acid are added. The composition provides 25 mg/mL phospholipids, 0.5 to 1.75 mg/mL triglycerides, 1.4 to 3.5 mg/mL free fatty acids, and <1.0 mg/mL total surfactant proteins. As an intratracheal suspension, it can be used for the prevention and treatment of neonatal respiratory distress syndrome. Survanta is manufactured by Abbvie.

Bubble CPAP is a non-invasive ventilation strategy for newborns with infant respiratory distress syndrome (IRDS). It is one of the methods by which continuous positive airway pressure (CPAP) is delivered to a spontaneously breathing newborn to maintain lung volumes during expiration. With this method, blended and humidified oxygen is delivered via short binasal prongs or a nasal mask and pressure in the circuit is maintained by immersing the distal end of the expiratory tubing in water. The depth to which the tubing is immersed underwater determines the pressure generated in the airways of the infant. As the gas flows through the system, it "bubbles" out and prevents buildup of excess pressures.

Surfactant therapy is the medical administration of exogenous surfactant. Surfactants used in this manner are typically instilled directly into the trachea. When a baby comes out of the womb and the lungs are not developed yet, they require administration of surfactant in order to process oxygen and survive. This condition that the baby has is called newborn respiratory distress syndrome, and it is treatable. Surfactant coat the smallest parts of the lungs called the alveoli and helps for oxygen to go in and for carbon dioxide to go out. How surfactant does this is by not allowing the alveoli to collapse and to retain their inflated shape when the baby exhales.

<span class="mw-page-title-main">Pulmonary surfactant (medication)</span>

Pulmonary surfactant is used as a medication to treat and prevent respiratory distress syndrome in newborn babies.

<span class="mw-page-title-main">Proning</span> Nursing technique

Proning or prone positioning is the placement of patients into a prone position so that they are lying on their front. This is used in the treatment of patients in intensive care with acute respiratory distress syndrome (ARDS). It has been especially tried and studied for patients on ventilators but, during the COVID-19 pandemic, it is being used for patients with oxygen masks and CPAP as an alternative to ventilation.

<span class="mw-page-title-main">Henry Halliday (paediatrician)</span> British neonatologist (1945–2022)

Henry Lewis Halliday was a British-Irish peaditrician and neonatologist. In 2021, Halliday was awarded the James Spence Medal for research into neonatology, for coordinating two of the largest neonatal multicentre trials for prevention and treatment of a number of neonatal respiratory illnesses and for a breakthrough in the development of a new lung surfactant that brought relief to very small babies suffering from infant respiratory distress syndrome (RDS).

References

  1. ↑ Verder, H; Agertoft, L; Albertsen, P; Christensen, NC; Curstedt, T; Ebbesen, F; Greisen, G; Hobolth, N; Holm, V; Jacobsen, T (Jul 27, 1992). "[Surfactant treatment of newborn infants with respiratory distress syndrome primarily treated with nasal continuous positive air pressure. A pilot study]". Ugeskrift for Laeger. 154 (31): 2136–9. PMID   1509593.
  2. ↑ "Henrik Verder research profile". www.Researchgate.net. Retrieved 15 July 2014.
  3. ↑ "Thesis" . Retrieved 15 July 2014.
  4. ↑ "Henrik Verder research profile". www.Researchgate.net. Retrieved 15 July 2014.
  5. ↑ Blennow, M; Jonsson, B; Dahlström, A; Sarman, I; Bohlin, K; Robertson, B (Mar 31, 1999). "[Lung function in premature infants can be improved. Surfactant therapy and CPAP reduce the need of respiratory support]". Läkartidningen. 96 (13): 1571–6. PMID   10218338.
  6. ↑ Verder, H; Agertoft, L; Albertsen, P; Christensen, NC; Curstedt, T; Ebbesen, F; Greisen, G; Hobolth, N; Holm, V; Jacobsen, T (Jul 27, 1992). "[Surfactant treatment of newborn infants with respiratory distress syndrome primarily treated with nasal continuous positive air pressure. A pilot study]". Ugeskrift for Laeger. 154 (31): 2136–9. PMID   1509593.
  7. ↑ Herting, E (Nov 2013). "Less invasive surfactant administration (LISA) - ways to deliver surfactant in spontaneously breathing infants". Early Human Development . 89 (11): 875–80. doi:10.1016/j.earlhumdev.2013.08.023. PMID   24075206.
  8. ↑ Verder, Henrik (1992). treatment of RDS in spontaneously breathing premature infants with surfactant administered intratracheal thought laryngeal mask. Berlin u.a.: XIIIth European Congress of Perinatal Medicine : Amsterdam, May 12–15, 1992. p. 137. ISBN   3110136244.
  9. ↑ Gregory, GA; Kitterman, JA; Phibbs, RH; Tooley, WH; Hamilton, WK (Jun 17, 1971). "Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure". The New England Journal of Medicine. 284 (24): 1333–40. doi:10.1056/NEJM197106172842401. PMID   4930602.
  10. ↑ Verder, H (Apr 2007). "Nasal CPAP has become an indispensable part of the primary treatment of newborns with respiratory distress syndrome". Acta Paediatrica. 96 (4): 482–4. doi:10.1111/j.1651-2227.2007.00263.x. PMID   17391463. S2CID   30292433.
  11. ↑ Morley, Colin; Gore, SheilaM.; Raju, TonseN.K.; Vidyasagar, Dharmapuri; Levy, PaulS. (1987). "Surfactants in Severe Hyaline Membrane Disease". The Lancet. 329 (8540): 1040–1041. doi:10.1016/S0140-6736(87)92316-6. S2CID   30443282.
  12. ↑ "Glostrup's observational home" . Retrieved 15 July 2014.
  13. ↑ "Nordic Chinese Article on Verder's collaboration in China" . Retrieved 30 July 2014.
  14. ↑ "Hospital article on Verder's collaboration in China". Archived from the original on 8 August 2014. Retrieved 30 July 2014.
  15. ↑ "Photo catalog on Verder's work in China". Archived from the original on 8 August 2014. Retrieved 30 July 2014.
  16. ↑ "Article on Infant program in China". Archived from the original on 6 August 2014. Retrieved 30 July 2014.
  17. ↑ "Chinese Article on Verder's work in China". Archived from the original on 6 August 2014. Retrieved 30 July 2014.
  18. ↑ Sundhed Magasinet (PDF). 2007. p. 55. Retrieved 29 July 2014.
  19. ↑ Red Barnet Projekt (PDF). Save the Children. March 1990. pp. 2–4. Retrieved 27 October 2014.
  20. ↑ "May Olofsson Director of the Family Center Linkedin Profile". Linkedin. Archived from the original on 6 August 2014. Retrieved 30 July 2014.
  21. ↑ Underbjerg, M; Kesmodel, US; Landrø, NI; Bakketeig, L; Grove, J; Wimberley, T; Kilburn, TR; Svaerke, C; Thorsen, P; Mortensen, EL (2012). "The effects of low to moderate alcohol consumption and binge drinking in early pregnancy on selective and sustained attention in 5-year-old children" (PDF). BJOG: An International Journal of Obstetrics & Gynaecology. 119 (10): 1211–1221. doi:10.1111/j.1471-0528.2012.03396.x. PMID   22712829. S2CID   31545281 . Retrieved 15 July 2014.
  22. ↑ Stevens, T. P.; Harrington, E. W.; Blennow, M.; Soll, R. F. (2007-10-17). "Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome". The Cochrane Database of Systematic Reviews. 2008 (4): CD003063. doi:10.1002/14651858.CD003063.pub3. ISSN   1469-493X. PMC   8554819 . PMID   17943779.
  23. ↑ "Henrik Verder research profile". www.Researchgate.net. Retrieved 15 July 2014.
  24. ↑ Verder, H; Robertson, B; Greisen, G; Ebbesen, F; Albertsen, P; Lundstrøm, K; Jacobsen, T (Oct 20, 1994). "Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. Danish-Swedish Multicenter Study Group". The New England Journal of Medicine. 331 (16): 1051–5. doi: 10.1056/nejm199410203311603 . PMID   8090164.
  25. ↑ Verder, H; Albertsen, P; Ebbesen, F; Greisen, G; Robertson, B; Bertelsen, A; Agertoft, L; Djernes, B; Nathan, E; Reinholdt, J (Feb 1999). "Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks' gestation". Pediatrics. 103 (2): E24. doi:10.1542/peds.103.2.e24. PMID   9925870.
  26. ↑ Verder, H; Ebbesen, F; Linderholm, B; Robertson, B; Eschen, C; Arrøe, M; Lange, A; Grytter, C; Bohlin, K; Bertelsen, A; Danish-Swedish Multicentre Study, Group (Jun 2003). "Prediction of respiratory distress syndrome by the microbubble stability test on gastric aspirates in newborns of less than 32 weeks' gestation". Acta Paediatrica. 92 (6): 728–33. doi:10.1080/08035250310002597. PMID   12856986.
  27. ↑ Verder, H; Ebbesen, F; Fenger-Grøn, J; Henriksen, TB; Andreasson, B; Bender, L; Bertelsen, A; Björklund, LJ; Dahl, M; Esberg, G; Eschen, C; Høvring, M; Kreft, A; Kroner, J; Lundberg, F; Pedersen, P; Reinholdt, J; Stanchev, H (2013). "Early surfactant guided by lamellar body counts on gastric aspirate in very preterm infants". Neonatology. 104 (2): 116–22. doi:10.1159/000351638. PMID   23942627. S2CID   2699650.
  28. ↑ Gluck, L; Kulovich, MV; Borer RC, Jr; Brenner, PH; Anderson, GG; Spellacy, WN (Feb 1, 1971). "Diagnosis of the respiratory distress syndrome by amniocentesis". American Journal of Obstetrics and Gynecology. 109 (3): 440–5. doi:10.1016/0002-9378(71)90342-5. PMID   5107880.
  29. ↑ Jessen, Torben E.; Höskuldsson, Agnar T.; Bjerrum, Poul J.; Verder, Henrik; Sørensen, Lars; Bratholm, Palle S.; Christensen, Bo; Jensen, Lene S.; Jensen, Maria A.B. (2014). "Simultaneous determination of glucose, triglycerides, urea, cholesterol, albumin and total protein in human plasma by Fourier transform infrared spectroscopy: Direct clinical biochemistry without reagents". Clinical Biochemistry. 47 (13–14): 1306–12. doi:10.1016/j.clinbiochem.2014.05.064. PMID   24943400.
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