Effects of surfactant treatment on gas-exchange and clinical course in near-term newborns with RDS.
OBJECTIVE
To determine if there is a relationship between acute improvement in pulmonary gas exchange and surfactant use in near-term (35-39 weeks' gestation) infants with respiratory distress syndrome (RDS).


METHODS
We examined retrospectively the records of 54 infants admitted during a 15 month period who were 35 or more weeks of gestation, and who demonstrated all the diagnostic features of RDS. Data analyzed included: birth weight; gestational age; Apgar scores; calculated alveolar to arterial oxygen gradient (AaDO2) and oxygenation index (0I); hours of life at intubation; surfactant administration; complications with surfactant administration; use of inotropic medications.


RESULTS
A total of 30 of infants were treated with intubation and surfactant administration. Mean FiO2 at the time of surfactant administration was 0.96. The AaDO2 decreased from 64.0 +/- 14.8 kPa to 41.8 +/- 22.5 kPa by 6 hrs (p < 0.0001). There was no relationship between age at treatment (6-89 hr) and response to treatment as measured by changes in AaDO2, FiO2, or oxygenation index (OI).


CONCLUSIONS
Near-term infants with severe RDS often respond to exogenous surfactant, suggesting a functional deficiency of endogenous surfactant at a "late" stage in their disease process. We speculate that delayed treatment may still be effective in these patients.
Golombek
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SG
Regional Neonatal Center, Westchester Medical Center, New York Medical College, Valhalla, New York, USA. sergio_golombek@nymc.edu
Truog
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WE
D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007440:Intubation; D008297:Male; D011659:Pulmonary Gas Exchange / Q000187:drug effects*; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy* / Q000503:physiopathology*; D012189:Retrospective Studies
D011663:Pulmonary Surfactants