127 Surfactant Administration by Elective Intubation in Near-Term Infants with Severe Respiratory Distress

Abstract

Background: premature infants born near-term may develop severe idiopathic respiratory distress requiring mechanical ventilation (MV). Aim: 1) to ascertain whether, in moderately premature infants with severe respiratory distress, a single dose of surfactant given by rapid intubation and extubation may reduce the entity of the disease and thus avoid MV; 2) to investigate whether infections or pulmonary hypertension may be associated with failure of surfactant treatment. Population: neonates weighing >=1500g at birth (35–37 weeks GA) and presenting with idiopathic respiratory distress requiring an FiO2>=0.70 or an FiO2>=0.6 (Silverman score >=7) to maintain an SaO2 of 90–95%. Infants were treated with oxygen and NCPAP or NSIPPV (Giulia, Ginevri) if necessary. Before surfactant was administered, a bronchoalveolar lavage was obtained for microbiological studies and echocardiography was used to evaluate pulmonary arterial pressures. Results: 18 infants (mean BW 2808g, 2230–3530, 13/18 born by C/S) received surfactant (Curosurf, 100 mg/kg) at an average age of 19h (1–54). The majority of chest radiographs showed retained lung fluid while, in a few cases, granular opacification with air bronchogram or widespread opacification of both lungs was seen. There was a marked and sustained decrease in FiO2 in those infants in whom surfactant treatment succeeded (FiO2 preINSURE: 0.68±0.10; FiO2 postINSURE at 3h 0.30±0.06; at 6h 0.29±0.06; at 12h 0.29±0.07; at 24h 0.26±0.05; ANOVA p<0.001). However, 28% of infants showed only a transitory decrease in FiO2 and eventually required MV. Among infants who failed, there were four cases of bacterial infections and one of pulmonary hypertension while no such complications were observed in infants who succeeded.Conclusions: A single dose of surfactant allows us to reduce the need for MV in most infants with severe respiratory distress at birth, except in cases with infections or pulmonary hypertension.