Evaluation of the Need for Prophylactic Surfactant at 27-28 Weeks Gestation

Abstract

Objective: Evaluate outcomes in 27-28 week gestation infants before and after a change in prophylactic surfactant guidelines. Materials and Methods: This retrospective chart review followed a change in NICU guidelines (January 2013) in which recommendations for prophylactic surfactant target population were changed from all infants under 29 weeks' to those under 27 weeks'. All 27-28 week infants born 24 months before (PRE) and 24 months after (POST) the guideline change were searched by database. Demographic data and outcomes were evaluated using non-parametric ANOVA and Dunn's multiple comparisons test. Results : In a NICU where 92% of its 27-28 week neonates receive at least one dose of prenatal steroids, the groups differed in only two outcome measures: surfactant doses and ventilator days after discontinuing prophylactic surfactant. Conclusions : This study suggests that there is no clear benefit and potential risk to prophylactic surfactant administration in 27-28 week gestation neonates. More studies may be useful to redefine criteria (or need) for prophylactic surfactant. Relevance: As prenatal steroids for prevention of respiratory distress syndrome has become more prevalent, we may need to reassess the routine use of surfactant in extremely and very low birthweight infants.