Early surfactant for neonates with mild to moderate respiratory distress syndrome: a multicenter, randomized trial*1

Abstract

<h2>Abstract</h2><h3>Objective</h3> We studied the efficacy and safety of electively providing surfactant to preterm infants with mild to moderate respiratory distress syndrome (RDS) not requiring mechanical ventilation. <h3>Study design</h3> A 5-center, randomized clinical trial was performed on 132 infants with RDS, birth weight ≥1250 grams, gestational age ≤36 weeks, postnatal age 4 to 24 hours, Fio₂ ≥40% for ≥1 hour, and no immediate need for intubation. Infants were randomly assigned to intubation, surfactant (Survanta, Ross Laboratories, Columbus, Ohio) administration, and expedited extubation (n=65) or expectant management (n=67) with subsequent intubation and surfactant treatment as clinically indicated. The primary outcome was duration of mechanical ventilation. <h3>Results</h3> Infants in the surfactant group had a median duration of mechanical ventilation of 2.2 hours compared with 0.0 hours for control infants, since only 29 of 67 control infants required mechanical ventilation (<i>P</i>=.001). Surfactant-treated infants were less likely to require subsequent mechanical ventilation for worsening respiratory disease (26% vs 43%, relative risk=0.60; 95% CI, 0.37, 0.99). There were no differences in secondary outcomes (duration of nasal continuous positive airway pressure, oxygen therapy, hospital stay, or adverse outcomes). <h3>Conclusions</h3> Routine elective intubation for administration of surfactant to preterm infants ≥1250 grams with mild to moderate RDS is not recommended.