Prophylactic administration of surfactant in extremely premature infants.

Lutz Koch,Bernd Beedgen,Johannes Poeschl,Peter Ruef,David Frommhold

doi:10.1155/2010/235894

Abstract

Objective. To investigate whether prophylactic surfactant administration is superior over selective treatment in preterm infants with respiratory distress syndrome (RDS). Methods. In our retrospective analysis, we compared premature infants (23 + 0 to 26 + 6 weeks) receiving 200 mg/kg surfactant (curosurf®) within five minutes after birth (prophylactic group, N = 31) with those infants who received surfactant therapy for established RDS (selective group, N = 34). Results. Prophylactic therapy significantly decreased the need for mechanical ventilation (74 hours per patient versus 171 hours per patient, resp.). We observed a reduced incidence of interstitial emphysema (0% versus 9%, resp.), pneumothoraces (3% versus 9%, resp.), chronic lung disease (26% versus 38%, resp.), and surfactant doses per patient (1.3 versus 1.8, resp.), although those variables did not reach significance. Conclusion. We conclude that infants under 27 weeks' gestation profit from prophylactic surfactant administration by reducing the time of mechanical ventilation. This in turn could contribute to reduce the risk for mechanical ventilation associated complications, without any detrimental short-term side effects.

Highlights

Evidence from randomized, controlled trials, as summarized in the Cochrane systematic reviews, demonstrates that prophylactic surfactant administration to infants judged to be “at risk” for developing respiratory distress syndrome, compared to selective use of surfactant in infants with established RDS, improved outcomes for high-risk preterm infants [1]
Prophylactic administration of surfactant may be preferable to rescue treatment, especially in infants
There were no significant differences between birthweight, gestational age, sex, use of antenatal steroids, APGAR-score, rate of SGA, and rate of multiple births of all patients treated in the observational period and historical control period as Table 1 shows

Summary

Introduction

Evidence from randomized, controlled trials, as summarized in the Cochrane systematic reviews, demonstrates that prophylactic surfactant administration to infants judged to be “at risk” for developing respiratory distress syndrome, compared to selective use of surfactant in infants with established RDS, improved outcomes for high-risk preterm infants [1]. Nasal CPAP is currently a first-line technique of respiratory support in newborns, and its use as an alternative to intubation and mechanical ventilation, in extremely low gestational age infants, is well documented [3, 4], but no clinical trial compared initial CPAP and rescue surfactant therapy with initial intubation and prophylactic surfactant administration. It remains unclear which criteria should be used to select “at risk” infants who would require prophylactic surfactant administration

Methods

Results

Discussion

Conclusion