Early surfactant for neonates with mild to moderate respiratory distress syndrome: a multicenter, randomized trial.
OBJECTIVE
We studied the efficacy and safety of electively providing surfactant to preterm infants with mild to moderate respiratory distress syndrome (RDS) not requiring mechanical ventilation.


METHODS
A 5-center, randomized clinical trial was performed on 132 infants with RDS, birth weight >or=1250 grams, gestational age <or=36 weeks, postnatal age 4 to 24 hours, Fio(2) >or=40% for >or=1 hour, and no immediate need for intubation. Infants were randomly assigned to intubation, surfactant (Survanta, Ross Laboratories, Columbus, Ohio) administration, and expedited extubation (n=65) or expectant management (n=67) with subsequent intubation and surfactant treatment as clinically indicated. The primary outcome was duration of mechanical ventilation.


RESULTS
Infants in the surfactant group had a median duration of mechanical ventilation of 2.2 hours compared with 0.0 hours for control infants, since only 29 of 67 control infants required mechanical ventilation (P=.001). Surfactant-treated infants were less likely to require subsequent mechanical ventilation for worsening respiratory disease (26% vs 43%, relative risk=0.60; 95% CI, 0.37, 0.99). There were no differences in secondary outcomes (duration of nasal continuous positive airway pressure, oxygen therapy, hospital stay, or adverse outcomes).


CONCLUSIONS
Routine elective intubation for administration of surfactant to preterm infants >or=1250 grams with mild to moderate RDS is not recommended.
Escobedo
Marilyn B
MB
University of Texas Southwestern Medical Center at Dallas (UTSW), Texas, USA.
Gunkel
John Harry
JH
Kennedy
Kathleen A
KA
Shattuck
Karen E
KE
Sánchez
Pablo J
PJ
Seidner
Steven
S
Hensley
Gaynelle
G
Cochran
Candace K
CK
Moya
Fernando
F
Morris
Brenda
B
Denson
Susan
S
Stribley
Richard
R
Naqvi
Mubariz
M
Lasky
Robert E
RE
D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy*
D011663:Pulmonary Surfactants