title: Early versus delayed surfactant administration in extremely premature neonates with respiratory distress syndrome ventilated by high-frequency oscillatory ventilation.
abstract: 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.
authors.affiliation: 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
authors.forename: Richard
authors.initials: R
authors.lastname: Plavka
authors.forename: Pavel
authors.initials: P
authors.lastname: Kopecký
authors.forename: Václav
authors.initials: V
authors.lastname: Sebron
authors.forename: Alena
authors.initials: A
authors.lastname: Leiská
authors.forename: Petr
authors.initials: P
authors.lastname: Svihovec
authors.forename: Josef
authors.initials: J
authors.lastname: Ruffer
authors.forename: Milena
authors.initials: M
authors.lastname: Dokoupilová
authors.forename: Blanka
authors.initials: B
authors.lastname: Zlatohlávková
authors.forename: Vlastimil
authors.initials: V
authors.lastname: Janus
authors.forename: Martin
authors.initials: M
authors.lastname: Keszler
mesh_terms: 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
chemical_list: D011663:Pulmonary Surfactants