An observational study of surfactant treatment in infants of 23-30 weeks' gestation: comparison of prophylaxis and early rescue.

OBJECTIVE

To test the clinical efficacy of exogenous surfactant for treatment of neonatal respiratory distress syndrome (RDS).

METHODS

In a retrospective multicenter observational study, data were collected on 987 infants of 23-30 weeks' gestation given surfactant for respiratory problems within 3 h of birth. Obstetric, neonatal and short-term outcome data were retrieved from recording charts and analyzed after subdivision of the sample into two treatment groups: prophylaxis (surfactant within 15 min) and early rescue (surfactant at 16-180 min).

RESULTS

A total of 965 infants were eligible for the study: 244 receiving prophylaxis and 721 receiving early rescue. The prophylaxis group had lower gestational ages and birth weights than the early rescue group (p = 0.0001), but were otherwise comparable. Natural surfactants were used in > 90% of infants in both groups. The rates of retreatments and the mean total doses of surfactant were similar in both groups. Babies receiving prophylaxis presented less grade 3-4 RDS than those receiving early rescue (32.4% vs. 53.8%, p = 0.0001). Those requiring prophylaxis also needed lower peak inspiratory pressure and had a shorter duration of oxygen therapy. Mortality and complications were similar between the groups, but babies receiving prophylaxis had less pulmonary interstitial emphysema (p = 0.0006) and periventricular leukomalacia (p = 0.0113) than infants receiving early rescue.

CONCLUSIONS

In clinical practice, prophylaxis was preferred in babies with lower birth weights and gestational ages compared to early rescue treatment. Not surprisingly, infants treated with prophylactic surfactant had a lower rate of RDS than the infants treated by early rescue, even though they did not need less surfactant overall.