Increased survival in low birth weight neonates given prophylactic surfactant.
OBJECTIVE
To compare the effectiveness of a prophylactic surfactant treatment strategy (PRO) to the effectiveness of a rescue (RESC) surfactant treatment strategy in patients at high risk for developing hyaline membrane disease (HMD).


METHODS
We analyzed data from a retrospective cohort consisting of all patients admitted to the neonatal intensive care units at the centers participating in the recently completed Infasurf-Survanta Comparative Trial. To be in the cohort, a patient had to be admitted during the trial, be <48 hours of age on admission, have a gestational age of <30 weeks, have a birth weight of 501 to 1250 gm, and be free of congenital anomalies. Twelve centers participated in this study. They contributed 1097 patients of whom 381 were treated with a PRO strategy.


RESULTS
Survival was significantly higher in the PRO-strategy patients (84% vs 72%, p < 0.05) as was survival without oxygen requirement at a postconceptional age of 36 weeks (60% vs 46%, p < 0.05). In addition, the patients with PRO had a lower prevalence of grade III and IV intraventricular hemorrhage (IVH, 9% vs 14%, p < 0.05). All analyses were controlled for birth weight and type of study center.


CONCLUSIONS
These data support the conclusion that using a PRO treatment strategy results in improved survival in patients at risk for developing HMD. A PRO treatment strategy may also decrease the likelihood of developing a severe IVH.
Brown
D R
DR
Newark Beth Israel Medical Center, Department of Pediatrics, NJ 07112, USA.
Bloom
B T
BT
Cohen
M
M
Myers
M M
MM
Egan
E A
EA
Kattwinkel
J
J
Delmore
P
P
Hall
R T
RT
Malloy
M H
MH
Holzman
I R
IR
Carlo
W A
WA
Pramanik
A K
AK
McCaffree
M A
MA
Weatherstone
K B
KB
Willett
L D
LD
Topper
W H
WH
D002543:Cerebral Hemorrhage / Q000150:complications; D006801:Humans; D006819:Hyaline Membrane Disease / Q000517:prevention & control*; D007226:Infant Mortality; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors
D011663:Pulmonary Surfactants