Surfactant treatment for spontaneously breathing preterm infants – Authors' reply

Abstract

Wolfgang Gopel and colleagues (Nov 5, p 1627) deserve kudos for their novel method of administering surfactant. However, there is no information on age at randomisation and number of patients intubated at baseline. In supplementary table 2, whether values for continuous positive airway pressure (CPAP) at 1 and 12 h of life were baseline variables or outcome variables is not clear. If these were post-randomisation variables, the subgroup analysis is clearly inap propriate. However, if CPAP status was a baseline variable as claimed, it means that at 1 h, 10·2% and 25·9% were mechanically ventilated in the intervention and standard treatment groups, respectively (p=0·003). At 12 h, 19·4% and 35·7% were mechanically ventilated in the intervention and standard treatment groups, respectively (p=0·007). There is an imbalance in the proportion ventilated at baseline, suggesting that patients in the standard treatment group had more severe disease than those in the intervention group. Previous surfactant treatment with intubation was not an exclusion criterion. How many patients in each group had received surfactant with intubation before randomisation? Patients in the intervention group received 100 mg/kg of surfactant. Did any patient in the standard treatment group receive 200 mg/kg as the fi rst dose of poractant? It would be interesting to know whether there were diff erences between patients getting poractant and beractant via catheter in terms of the lowest heart rate and lowest peripheral oxygen saturation reached during administration. Diff er ences could aff ect the generalisability of the fi ndings to units that predominately use beractant.