Late Administration of Surfactant May Increase the Risk of Patent Ductus Arteriosus.

Fuat Emre Canpolat,H Gözde Kanmaz Kutman,James Webbe,Mehmet Büyüktiryaki,Sarkhan Elbayiyev,Gülsüm Kadıoğlu Şimşek,Nazmiye Bengü Karaçağlar

doi:10.3389/fped.2020.00130

Fuat Emre Canpolat, H Gözde Kanmaz Kutman + Show 5 more

Open Access

https://doi.org/10.3389/fped.2020.00130

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Abstract

Introduction: Early rescue surfactant is the most effective way of administering surfactant but many infants still receive surfactant later. Our aim was to explore the association between timing of surfactant administration and the development of patent ductus arteriosus and other neonatal morbidities.Materials and method: This retrospective study analyzed 819 preterm infants under 30 weeks of gestational age and under 1,500 g.Results: Five hundred and ninety three infants received surfactant during the study period, of these 365 received it within 2 h of life (early group) and 228 received it after two h (late group). Patent ductus arteriosus was detected in 175 (48%) of the early group and 168 (74%) of the late group, p = 0.001. Multinominal logistic regression analysis demonstrated that receiving surfactant after 2 h of life has a OR 3.5 (2.2–5.64 95 % CI) and a p-value of 0.001 for developing patent ductus arteriosus.Conclusion: In this study population we observed that late surfactant administration is associated with increased risk of patent ductus arteriosus.

Highlights

Rescue surfactant is the most effective way of administering surfactant but many infants still receive surfactant later
We divided the patients into two groups based on timing of surfactant therapy: the early surfactant group (365 infants) receiving surfactant within 2 h of life and the late group (228 infants) receiving it after 2 h
Preterm infants with major congenital anomalies, infants with futile or palliative care, and missing information about surfactant administration time were excluded from the study

Summary

Introduction

Rescue surfactant is the most effective way of administering surfactant but many infants still receive surfactant later. Respiratory distress syndrome (RDS) is the most common respiratory disease among preterm infants. Surfactant replacement therapy is an effective treatment for respiratory distress syndrome [1]. Surfactant therapy has been shown to reduce disease severity and air leaks leading to improved survival [1]. Management has evolved gradually over the years early rescue surfactant administration is superior to late treatment [2]. Previous trials showed that surfactant given earlier in the course of disease works better than later in terms of reducing air leaks [2] and avoiding mechanical ventilation if the intubate-surfactant-extubate (INSURE) technique is used [3]. European Consensus Guideline 2019 recommended that early rescue surfactant should be standard [1] and there are occasions when surfactant should be given in the delivery suite, such as when intubation is needed for stabilization

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