Abstract
Background: Surfactant replacement therapy (SRT) is an integral part of management of preterm surfactant deficiency respiratory distress syndrome (RDS). Its role in the management of RDS has been extensively studied. However, its efficacy in the management of lung disease in preterm infants born with intrauterine growth restriction (IUGR) has not been systematically studied.Objective: To evaluate the efficacy of exogenous SRT in the management of preterm IUGR lung disease.Methods: A systematic search of all available randomized clinical trials (RCT) of SRT in preterm IUGR infants was done according to the standard Cochrane collaboration search strategy. Neonatal respiratory outcomes were compared between the preterm IUGR and appropriately grown for gestational age (AGA) preterm infant populations in eligible studies.Results: No study was identified which evaluated the efficacy or responsiveness of exogenous SRT in preterm IUGR infants as compared to preterm AGA-infants. The only study identified through the search strategy used small for gestational age (SGA; defined as less than tenth centile for birth weight) as a proxy for IUGR. The RCT evaluated the efficacy or responsiveness of SRT in preterm SGA group as compared to AGA-infants. The rate of intubation, severity of RDS, rate of surfactant administration, pulmonary air leaks, and days on the ventilator did not differ between both groups. However, the requirement for prolonged nasal continuous positive airway pressure (p < 0.001), supplemental oxygen therapy (p < 0.01), and the incidence of bronchopulmonary dysplasia at 28 days and 36 weeks (both p < 0.01) was greater in SGA-infants.Discussion: There is currently insufficient data available to evaluate the efficacy of SRT in preterm IUGR lung disease. A variety of research strategies will be needed to enhance our understanding of the role and rationale for use of SRT in preterm IUGR lung disease.
Highlights
Introduction of surfactant replacement therapy (SRT) in the 1990s marked the beginning of a new era in the management of prematurity-related surfactant deficiency and its clinical sequelae, respiratory distress syndrome (RDS) [1]
The only study identified through the search strategy used small for gestational age (SGA; defined as less than tenth centile for birth weight) as a proxy for intrauterine growth restriction (IUGR)
We present the current understanding of preterm IUGR lung disease first and discuss the role of exogenous surfactant
Summary
Introduction of surfactant replacement therapy (SRT) in the 1990s marked the beginning of a new era in the management of prematurity-related surfactant deficiency and its clinical sequelae, respiratory distress syndrome (RDS) [1]. Intrauterine growth restriction and prematurity are two important pregnancy complications that lead to high rates of mortality and morbidity in neonates. They commonly co-exist, and thereby potentiate the risk of adverse outcomes [8]. Compared to appropriately grown age-matched counterparts, IUGR babies have higher mortality rates, are at significant risk for reduced postnatal growth and development, and have increased incidence of morbidities such as RDS, bronchopulmonary dysplasia (BPD), retinopathy of prematurity, and necrotizing enterocolitis [13,14,15]. Surfactant replacement therapy (SRT) is an integral part of management of preterm surfactant deficiency respiratory distress syndrome (RDS). Its efficacy in the management of lung disease in preterm infants born with intrauterine growth restriction (IUGR) has not been systematically studied
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