Is Early Surfactant Administration Associated with Reduced Mortality in the Late Preterm Infant?

Abstract

Background: The late preterm infant is at great risk of neglect because it is perceived as near term, however this group suffers from disease due to prematurity and needs great attention. Surfactant use is a well-established intervention that improves outcomes in preterm infants however the timing of its use in this group is not well studied. Objective: To assess whether administration of surfactant within 30 min of birth when clinically indicated reduces mortality in the late preterm infant, and to compare rates of early surfactant use and mortality to international trends using the Vermont Oxford Network database. Methods: This was a retrospective study conducted at private neonatal ICU in Gauteng, where data were collected from 2002 to 2013. Data on mortality and surfactant use were compiled using the online database called the Vermont Oxford Network. Comparisons were then made between the periods where surfactant was administered early and when they were not. Results: A total of 3040 cases were retrieved over the study period 2002 to 2013. The mean age of the population was 35-1/7 weeks and the mean birth weight was 2222.32 grams. During the study period, early surfactant administration rose to 90.62% compared to the VON which was averaged at 32.53%. Mortality dropped from 3.12% to 0.39% during the interventional period. This was significantly lower than the VON's mortality of 1.21% (p<0.05). A strong inverse correlation between early surfactant use and mortality was observed with the Pearson correlation coefficient being -0.86 (p<0.05). Conclusion: This study showed that for the late preterm infant, early surfactant use within 30 minutes of birth was significantly higher at the study center than international trends. It also demonstrated that mortality was lower, and that a strong inverse correlation was found between mortality and early surfactant use. Being a retrospective study, there is the possibility of confounding variables, and so a double blind controlled study is needed to explore the timing of surfactant administration in the late preterm infant.