title: High-dose versus low-dose bovine surfactant treatment in very premature infants.
abstract: The aim of the study was to determine if high-dose bovine surfactant (Alveofact, initially 100 mg/kg birth weight) would improve oxygenation compared with low-dose surfactant (50 mg/kg birth weight) administered intratracheally within 1 h after birth. Inclusion criteria included gestational age 24-29 weeks and birth weight 500-1500 g, intubation and mechanical ventilation, absence of congenital malformations and bacterial infections. Retreatment was considered if the fraction of inspired oxygen (FiO2) was > 0.4 (dose 50 mg/kg birth weight). The primary endpoint was level of oxygenation (PaO2/FiO2) 2 h after treatment. The study design was a sequential analysis using a triangular test with alpha = 0.05 and 95% power to detect a 25% improvement in the endpoint. Oxygenation was improved significantly with high-dose (n = 42) compared to low-dose treatment (n = 48): 30.9 +/- 15.0 kPa (231.5 +/- 112.7 mmHg) versus 24.1 +/- 15.7 kPa (180.6 +/- 118.0 mmHg) (mean +/- SD). The survival rate was 83% in both groups and the incidence of pulmonary interstitial emphysema was 33% versus 14% with the high-dose treatment. We conclude that high-dose surfactant significantly improved oxygenation and reduced lung barotrauma. An initial dose greater than 50 mg/kg birth weight of surfactant is required for optimal acute response.
authors.affiliation: University Children's Hospital, Ulm, FRG.
authors.forename: L
authors.initials: L
authors.lastname: Gortner
authors.forename: F
authors.initials: F
authors.lastname: Pohlandt
authors.forename: P
authors.initials: P
authors.lastname: Bartmann
authors.forename: U
authors.initials: U
authors.lastname: Bernsau
authors.forename: F
authors.initials: F
authors.lastname: Porz
authors.forename: H H
authors.initials: HH
authors.lastname: Hellwege
authors.forename: R C
authors.initials: RC
authors.lastname: Seitz
authors.forename: G
authors.initials: G
authors.lastname: Hieronimi
authors.forename: E
authors.initials: E
authors.lastname: Kuhls
authors.forename: G
authors.initials: G
authors.lastname: Jorch
mesh_terms: D004305:Dose-Response Relationship, Drug; D005260:Female; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood / Q000401:mortality / Q000517:prevention & control*; D008055:Lipids / Q000008:administration & dosage*; D008297:Male; D010100:Oxygen / Q000097:blood; D010743:Phospholipids; D011656:Pulmonary Emphysema / Q000517:prevention & control; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000097:blood / Q000401:mortality / Q000517:prevention & control*; D015996:Survival Rate
chemical_list: D008055:Lipids; D010743:Phospholipids; D011663:Pulmonary Surfactants; C078272:SF-RI 1, bovine surfactant preparation; D010100:Oxygen