Pre and Post Surfactant: Outcome of Inborn and Outborn Infants, 23-26 Weeks' Gestation. † 1182

Abstract

Objective: To determine the impact of surfactant use in an inborn (I) and outborn (O) population of infants 23-26 weeks gestation. Methods: All live born infants, 23-26 weeks gestation born in a perinatal center (I) and admitted to a teritary care unit (O) were considered; those with major congenital abnormalities were excluded. Data from 1982-87, presurfactant (Pre), were compared with 1991-94, postsurfactant (Post). Outcomes included mortality and gross morbidity (cerebral palsy, cognitive impairment, blindness &/or deafness) at 18-24 months corrected age. Intact survivors were those without gross morbidity, excluding those lost to follow up (N=66 (7%)). Statistical analyses of outcome between pre and post surfactant era and in surfactant treated and non treated patients were performed. Results: Pre I (N=321), Post I (N=241); Pre O (N=247), Post O (N=173). Mean birth weights and gender between I and O and Pre and Post were similar. In O, there were no significant differences Pre and Post in mortality and intact survival rates, although untreated patients in Post had a significantly better survival (p<0.0001). In I, overall mortality was also unchanged Pre and Post, however intact survival improved (*p<0.05) in the Post era. In treated vs untreated infants, there were no significant differences for either mortality or intact survival, except at 23 weeks where nonviable infants were not treated. Conclusions: Surfactant therapy has not improved mortality rates at 23-26 weeks gestation. Intact survival in the inborn population improved in the postsurfactant era, unrelated to surfactant treatment. Table