title: Early extubation and nasal continuous positive airway pressure after surfactant treatment for respiratory distress syndrome among preterm infants <30 weeks' gestation.
abstract: OBJECTIVE
  To test the hypothesis that preterm infants with infant respiratory distress syndrome who are treated with nasal continuous positive airway pressure (NCPAP) and surfactant administration followed by immediate extubation and NCPAP application (SURF-NCPAP group) demonstrate less need for mechanical ventilation (MV), compared with infants who receive MV after surfactant administration (SURF-MV group).
  
  
  METHODS
  A prospective randomized study was conducted, in which infants <30 weeks' gestation were randomized to the SURF-NCPAP group or the SURF-MV group.
  
  
  RESULTS
  At 7 days of life, no patient in the SURF-NCPAP group but 6 patients (43%) in the SURF-MV group still were undergoing MV. The duration of oxygen therapy, NCPAP, and MV, the need for a second dose of surfactant, and the length of stay in the intensive care unit were significantly greater in the SURF-MV group.
  
  
  CONCLUSIONS
  The immediate reinstitution of NCPAP after surfactant administration for infants with infant respiratory distress syndrome is safe and beneficial, as indicated by the lesser need for MV and the briefer requirement for respiratory supports, compared with the institution of MV after surfactant treatment. Moreover, this strategy contributed to reducing the need for surfactant treatment and reducing the time and costs involved in keeping the infants in the neonatal intensive care unit.
authors.affiliation: Department of Surgical and Medical Critical Care, Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy. cdani@unifi.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Dani
authors.forename: Giovanna
authors.initials: G
authors.lastname: Bertini
authors.forename: Marco
authors.initials: M
authors.lastname: Pezzati
authors.forename: Alessandra
authors.initials: A
authors.lastname: Cecchi
authors.forename: Cosimo
authors.initials: C
authors.lastname: Caviglioli
authors.forename: Firmino F
authors.initials: FF
authors.lastname: Rubaltelli
mesh_terms: D045422:Continuous Positive Airway Pressure; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007902:Length of Stay; D008297:Male; D010102:Oxygen Inhalation Therapy; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015300:Ventilator Weaning
chemical_list: D011663:Pulmonary Surfactants