Early surfactant in spontaneously breathing with nCPAP in ELBW infants--a single centre four year experience.
OBJECTIVE
To evaluate whether the experience with a method to administer surfactant during spontaneous breathing with nasal continuous positive airway pressure (nCPAP) as primary respiratory support in infants with respiratory distress syndrome (RDS) influences the frequency of its use and affects the outcome of patients.


METHODS
All inborn extremely low birthweight (ELBW) infants treated after introduction of the method were retrospectively studied (n=196). The entire observational period was divided into four periods (periods 1-4) and compared with a control period (period 0) (n=51). Primary respiratory support, demographics, prenatal risks and outcomes were compared.


RESULTS
There were no changes in demographics or prenatal risks over time. The choice of nCPAP as initial airway management significantly increased from 69% to 91% and for nCPAP with surfactant from 75% to 86%. The rate of nCPAP failure decreased from 46% to 25%. Survival increased significantly between periods 0 and 1 from 76% to 90% and survival without bronchopulmonary dysplasia (BPD) rose from 65% to 80%. No changes in nonpulmonary outcomes were observed.


CONCLUSIONS
The success of nCPAP increased with increasing use of nCPAP with surfactant. Simultaneously, mortality decreased without deterioration of other outcomes indicating that the use of surfactant in spontaneous breathing with nCPAP could be beneficial.
Kribs
Angela
A
Department of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany. angela.kribs@uk-koeln.de
Vierzig
Anne
A
Hünseler
Christoph
C
Eifinger
Frank
F
Welzing
Lars
L
Stützer
Hartmut
H
Roth
Bernhard
B
D005260:Female; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D011175:Positive-Pressure Respiration; D012127:Respiratory Distress Syndrome, Newborn / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013501:Surface-Active Agents / Q000008:administration & dosage*; D016896:Treatment Outcome
D013501:Surface-Active Agents