Differences in immediate and short-term outcome of premature neonates treated with two types of exogenous surfactant preparation.
A retrospective review of the use of 2 types of exogenous surfactants was done to detect any differences in the short-term outcome. A total of 77 babies received surfactant replacement during the 1 year and 6 months under review. Of these, 30 had received a modified natural preparation, Survanta, and 47 had received a synthetic preparation, Exosurf. The median age at which the surfactant had been administered was at 4 hours of life. Twenty-three percent of all infants had received antenatal steroids. The infants who had received Survanta showed a more rapid initial response, with a lowering of oxygen requirements 1 hour after administration and improvements in the alveolar-arterial oxygen ratios. At 4 hours after administration, the mean arterial-alveolar oxygen ratio was 0.25 +/- 0.15 in the group given Survanta compared with 0.17 +/- 0.11 in the group treated with Exosurf (P < 0.05). These differences however did not persist beyond the first 12 hours after therapy. There were no significant differences between the 2 groups of infants in terms of survival, development of bronchopulmonary dysplasia, intraventricular haemorrhage or ventilator days. A haemodynamically significant patent ductus arteriosus was clinically evident significantly earlier in babies who had received Survanta (mean age 1.86 days against 2.38 days, P = 0.04). The modified natural surfactants appeared to have a more rapid onset of action. The haemodynamic consequences of this more rapid onset of action have to be anticipated in such infants.
Malathi
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Department of Neonatology II, Kandang Kerbau Hospital, Singapore.
Ng
K C
KC
D001688:Biological Products; D001997:Bronchopulmonary Dysplasia / Q000209:etiology; D002543:Cerebral Hemorrhage / Q000209:etiology; D004338:Drug Combinations; D004374:Ductus Arteriosus, Patent / Q000503:physiopathology; D005233:Fatty Alcohols / Q000008:administration & dosage / Q000737:chemistry / Q000627:therapeutic use; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006819:Hyaline Membrane Disease / Q000188:drug therapy*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D007235:Infant, Premature, Diseases / Q000188:drug therapy*; D008297:Male; D010100:Oxygen / Q000008:administration & dosage; D010767:Phosphorylcholine; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000737:chemistry / Q000627:therapeutic use; D011663:Pulmonary Surfactants / Q000008:administration & dosage / Q000737:chemistry / Q000627:therapeutic use*; D012123:Pulmonary Ventilation / Q000187:drug effects; D012074:Remission Induction; D012121:Respiration, Artificial; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014692:Ventilation-Perfusion Ratio / Q000187:drug effects
D001688:Biological Products; D004338:Drug Combinations; D005233:Fatty Alcohols; D011663:Pulmonary Surfactants; D010767:Phosphorylcholine; D011092:Polyethylene Glycols; C047049:dipalmitoylphosphatidylcholine, hexadecanol, tyloxapol drug combination; C072197:beractant; D010100:Oxygen