Early versus delayed surfactant administration in extremely premature neonates with respiratory distress syndrome ventilated by high-frequency oscillatory ventilation.
OBJECTIVE
To determine whether early surfactant administration is superior to selective delayed treatment in terms of improving survival and/or reducing chronic lung disease in extremely premature neonates with respiratory distress syndrome (RDS) treated by high-frequency oscillatory ventilation (HFOV).


METHODS
Prospective randomized clinical trial.


METHODS
Tertiary neonatal intensive care unit (NICU) in the Perinatology Center of Prague.


METHODS
Forty-three extremely premature infants who needed artificial ventilation within 3 h after delivery.


METHODS
Patients were randomly assigned to either early ( n=21) or delayed (n=22) administration of surfactant. All were ventilated by HFOV as the primary mode of ventilation using the high volume strategy aimed at optimizing lung volume. Curosurf at a dose of 100 mg/kg was given as a single bolus via the endotracheal tube within 1 min immediately after intubation in the early group (EARL), or during HFOV only when defined criteria were reached in the delayed (DEL) group.


RESULTS
No differences were noted in demographic data between the two groups. Fewer infants randomized to the EARL group required oxygen use or died at 36 weeks (combined outcome 29% vs 64%, p=0.021), and there was a lower incidence of any intraventricular hemorrhage in this group (43 vs 82%, p=0.008).


CONCLUSIONS
When compared to delayed dosing, early administration of surfactant followed by HFOV facilitates and accelerates respiratory stabilization during the acute phase of severe RDS, may reduce the incidence of chronic lung disease or death and may positively influence the incidence of severe intracranial pathology in extremely premature infants with primary surfactant insufficiency.
Plavka
Richard
R
Department of Obstetrics and Gynecology, Division of Neonatology, General Hospital of the 1st Medical Faculty, Charles University, 18 Apolinárská Street, 128 00 Prague, Czech Republic. plavka@mbox.vol.cz
Kopecký
Pavel
P
Sebron
Václav
V
Leiská
Alena
A
Svihovec
Petr
P
Ruffer
Josef
J
Dokoupilová
Milena
M
Zlatohlávková
Blanka
B
Janus
Vlastimil
V
Keszler
Martin
M
D002908:Chronic Disease; D018153:Czech Republic; D006612:High-Frequency Ventilation; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D011292:Premedication; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000008:administration & dosage* / Q000627:therapeutic use; D012044:Regression Analysis; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy* / Q000517:prevention & control; D016896:Treatment Outcome
D011663:Pulmonary Surfactants