Factors affecting the neonatal response to artificial surfactant.
OBJECTIVE
To define the individual neonatal response to the artificial surfactant, Exosurf, and factors that may influence the response.


METHODS
Eighty-two consecutive, preterm neonates with respiratory distress syndrome, who received Exosurf at < 12 h of age were studied. Their response was categorized from the graphical change in the oxygenation index with postnatal age, for 12 h after each of two doses of surfactant and assessed independently by two observers. Clinical factors were analysed for their effect on the four pre-defined categories of response, namely: none; mild; good: relapsed; and good: sustained.


RESULTS
Within the first 12 h, 11% of the neonatas showed no response, 5% a mild response and 84% a good response, but 34% relapsed. By 24 h, 6% still showed no response (all died), 11% showed a mild response and 83% a good response, of whom half relapsed. At 24 h, no response was significantly associated with low gestational age and asphyxia, mild response with less severe lung disease. According to the response there was a gradation in the risk of death during the first week.


CONCLUSIONS
The response to Exosurf can be individually and reproducibly categorized and demonstrated that 83% of neonates had a good response but half relapsed. No response was associated with extreme prematurity and asphyxia.
Skelton
R
R
Department of Perinatal Medicine, King George V Hospital, New South Wales, Australia.
Jeffery
H E
HE
D000280:Administration, Inhalation; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D004338:Drug Combinations; D005069:Evaluation Studies as Topic; D005233:Fatty Alcohols / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D010101:Oxygen Consumption / Q000187:drug effects; D010767:Phosphorylcholine; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000627:therapeutic use*; D011663:Pulmonary Surfactants / Q000008:administration & dosage / Q000627:therapeutic use*; D012119:Respiration / Q000187:drug effects* / Q000502:physiology; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome
D004338:Drug Combinations; D005233:Fatty Alcohols; D011663:Pulmonary Surfactants; D010767:Phosphorylcholine; D011092:Polyethylene Glycols; C047049:dipalmitoylphosphatidylcholine, hexadecanol, tyloxapol drug combination