EFFECTS OF BOVINE LIPID EXTRACT SURFACTANT (BLES) ADMINISTRATION IN PRETERM INFANTS TREATED FOR RESPIRATORY DISTRESS SYNDROME

Abstract

BACKGROUND: Surfactant therapy is effective in improving the clinical outcomes of premature infants with respiratory distress syndrome (RDS). Bovine Lipid Extract Surfactant (BLES®) is commonly used to treat RDS in premature infants in Neonatal Intensive Care Units (NICU) across Canada. OBJECTIVES: To describe the length of time to wean to room air following the administration of BLES for the treatment of RDS in premature infants as per local evidence-based practice guideline. DESIGN/METHODS: Retrospective review of data collected from infants born < 37 weeks with RDS treated with surfactant replacement therapy between February 1, 2015 and March 1, 2016. Data were analysed to determine the timing of initial surfactant administration, length of time to wean to room air and number of doses required. Infants were sub grouped within gestational age stratum; 230 weeks to 276 weeks (extreme preterm - group 1), 280 weeks to 316 weeks (very preterm - group 2) and 320 weeks to 366 weeks (group 3). RESULTS: Ninety eight premature infants with RDS were treated with surfactant during the study period. Twenty one infants were excluded due to incomplete data collection (16/21) and ongoing oxygen requirement prior to second dose of surfactant (5/21).Seventy seven infants were analysed; mean gestational age and birth weight were 286 weeks (SD 3.5) and 1250 grams (SD 602). Forty infants (52%) were in group 1, 21 (27%) in group 2 and 16 (21%) in group 3.The initial dose of surfactant in group 1 was given at a median time of 29 minutes (IQR=24) after birth compared to 150 minutes (IQR=595) in group 2 and 990 minutes (IQR=1973) in group 3 (c2=21.89, p<0.001). Median length of time to wean to room air was 14 minutes (IQR=51) in group 1, 10 minutes (IQR=48) in group 2, and 10 minutes (IQR=33) in group 3 (p=0.88). Only 6% of all infants required repeated doses of BLES, 4 infants in group 1 and 1 infant in group 3. CONCLUSION: Extreme preterm infants received their initial dose of BLES® earlier in their RDS management. Given the rapid response to BLES® in the entire patient population, careful monitoring of ventilator parameters should be made, allowing for rapid weaning and eventual extubation after surfactant administration.