[Surfactant treatment of newborn infants receiving continuous positive airway pressure treatment].
BACKGROUND
The purpose of this study was to examine the efficiency of a single dose of fast-acting exogenous surfactant (Curosurf) given to premature babies with progressive respiratory insufficiency. Curosurf was given as early rescue therapy during a brief intubation (INSURE method: INtubation-SURfactant-Extubation) during treatment with nasal Continuous Positive Airway Pressure (CPAP).


METHODS
Retrospective study of 115 premature infants with respiratory distress syndrome born and treated at Odense University Hospital during the years 1999 to 2004. The criterion for surfactant treatment was a decrease in the arterial/alveolar oxygen tension ratio (or corresponding values for the fraction of inspired oxygen) below 0.36 in infants with gestational age (GA) < 30 weeks and 0.22 in more mature infants.


RESULTS
The primary end point was survival during the first week of life without mechanical ventilation. This end point was reached by 51% of the infants with GA < 30 weeks. However, the effect proved to be GA-dependent, increasing from 22% in infants with a GA of 24-25 weeks to 86% in week 29. Seventy percent survived to be discharged. In infants with GA > 29 weeks the effect was 87%, and all survived.


CONCLUSIONS
The effect of surfactant therapy administered per the INSURE method is GA-dependent, and the method works best after GA week 25. The question is whether earlier therapy will increase its efficiency or the method has reached its limit.
Andersen
Tina
T
Odense Universitetshospital, Børneafdeling H.
Holm
Hanne Spangsberg
HS
Kamper
Jens
J
D001688:Biological Products / Q000008:administration & dosage*; D045422:Continuous Positive Airway Pressure; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D010743:Phospholipids / Q000008:administration & dosage*; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
D001688:Biological Products; D010743:Phospholipids; D011663:Pulmonary Surfactants; C068291:poractant alfa