title: The selection of infants for surfactant replacement therapy under conditions of limited financial resources.
abstract: The cost of surfactant replacement therapy (SRT) will restrict its use under conditions of limited health resources. Before the local advent of SRT, infants ventilated for hyaline membrane disease (HMD) had an overall survival rate of 87% and an incidence of bronchopulmonary dysplasia of 6.4%. This, together with the cost of SRT, prompted a study to identify those infants who would benefit the most from SRT. Twenty-two infants assessed as having severe HMD were randomised to receive SRT at 3 - 4 hours (9) or at 6 - 8 hours (13) after birth. Two infants (15%) in the latter group did not require SRT. The outcome of these two groups was the same. Of 56 infants assessed as having moderate HMD, only 24 (43%) qualified for SRT from 6 hours of age. The outcome of the SRT and non-SRT infants was comparable. The group of infants with moderate HMD had a significantly better outcome than those with severe HMD. A limited period of observation to assess the severity of illness did not compromise outcome in this group of 78 infants with moderate to severe HMD.
mesh_terms: D005260:Female; D015276:Health Care Rationing; D006801:Humans; D006819:Hyaline Membrane Disease / Q000188:drug therapy* / Q000191:economics; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018579:Patient Selection; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D011663:Pulmonary Surfactants