[Early selective surfactant treatment--also to very premature infants treated with CPAP?].
BACKGROUND
Early selective surfactant treatment of premature infants on mechanical ventilation, defined as treatment of selected children within the first two hours of life, reduces the incidence of complications to neonatal respiratory distress syndrome (RDS) as compared with delayed selective surfactant treatment. Treatment of children judged to be solely at risk of RDS, however, eventually leads to overtreatment in some.


METHODS
A population of premature neonates born at a gestational age of 24 + 0 to 29 + 6 weeks at Rigshospitalet, were studied retrospectively.


RESULTS
Of the 171 children supported by nasal continuous positive airway pressure (CPAP) at the age of two hours, 99 were eventually treated with a natural surfactant (Curosurf) at a median age of nine hours. A statistically significant association was found between later surfactant treatment and an oxygen supplement of more than 30% at the age of two hours (chi 2: p < 0.001). Furthermore, there was a statistically significant association between later surfactant treatment and birth as the second twin or second or third triplet (chi 2: p < 0.001). Surprisingly, a gestational age of between 24 + 0 and 27 + 6 weeks, a birth weight less than 1.000 g, and a birth weight less than 80% of that expected was not correlated with later surfactant treatment. Forty-nine per cent of the children treated with surfactant received mechanical ventilation at some time before discharge.


CONCLUSIONS
Earlier selective surfactant treatment of premature neonates supported by nasal CPAP with an oxygen supplement of more than 30% at the age of two hours would have been possible in 71 of 99 children needing the surfactant. As a consequence, 13 of 72 children would have been overtreated.
Klamer
A
A
Greisen
G
G
D001688:Biological Products; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D010743:Phospholipids; D011175:Positive-Pressure Respiration; D017410:Practice Guidelines as Topic; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy* / Q000517:prevention & control / Q000628:therapy
D001688:Biological Products; D010743:Phospholipids; D011663:Pulmonary Surfactants; C068291:poractant alfa