title: Early administration of the second dose of surfactant (beractant) in the treatment of severe hyaline membrane disease.
abstract: The aim of this study was to demonstrate that administration of the second dose of beractant 2 h after the first one is more effective than 6 h after the initial dose. The inclusion criteria for the recruitment of newborn infants were: age < or = 8 h, birthweight 600-2000 g, gestational age 23-36 wk, need for mechanical ventilation with inspiratory oxygen fraction (FiO2) > or = 0.4 and mean airway pressure (MAP) > or = 7 cmH2O to obtain arterial oxygen tension (PaO2) values between 70 and 80 mmHg, and thoracic X-ray compatible with hyaline membrane disease (HMD). Newborns with major congenital malformations, hydrops fetalis or severe pulmonary hypoplasia, or being treated with high-frequency oscillatory ventilation were excluded. In total, 57 premature newborns were studied, 20 of them below 1000 g, who received 100 mg kg-1 of beractant in 2 aliquots and showed an inadequate response, i.e. after 2 h of the first dose the newborn still needed a FiO2 > or = 0.4 and a MAP > or = 7 cmH2O to achieve a PaO2 > 70 mmHg. The second dose was randomly administered 2 or 6 h from the first one.
  
  
  CONCLUSIONS
  The 2 study groups were comparable except for a higher need of dopamine and seroalbumin in 2-h group. Evolution and complications were similar. Twelve hours after the first dose, the percentage improvement in the arteriolar/alveolar ratio (a/ADO2) in the 2-h group was similar to that in the 6-h group. However, in newborns below 1000 g, 12 h after the first dose the a/ADO2 percentage improvement in the 2-h group was greater than in 6-h group (median of 103.6% vs 16.3%; p = 0.035). In premature infants below 1000 g, it seems reasonable to advance the second dose of beractant if needed.
authors.affiliation: Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic, University of Barcelona, Barcelona, Spain. figueras@medicina.ub.es
authors.forename: J
authors.initials: J
authors.lastname: Figueras-Aloy
authors.forename: J
authors.initials: J
authors.lastname: Quero
authors.forename: X
authors.initials: X
authors.lastname: Carbonell-Estrany
authors.forename: G
authors.initials: G
authors.lastname: Ginovart
authors.forename: J
authors.initials: J
authors.lastname: Pérez-Rodríguez
authors.forename: F
authors.initials: F
authors.lastname: Raspall
authors.forename: J M
authors.initials: JM
authors.lastname: Rodríquez Miguélez
authors.forename: M D
authors.initials: MD
authors.lastname: Salvía
mesh_terms: D001688:Biological Products; D005260:Female; D006801:Humans; D006819:Hyaline Membrane Disease / Q000188:drug therapy*; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D001688:Biological Products; D011663:Pulmonary Surfactants; C072197:beractant