title: Surfactant without intubation in preterm infants with respiratory distress: first multi-center data.
abstract: BACKGROUND
  Recently in a report of a single center a method has been described to apply surfactant via a thin endotracheal catheter to very low birth weight infants spontaneously breathing with nasal continuous positive airway pressure. We now analyzed available multicenter data.
  
  
  METHODS
  In a multicenter study investigating genetic risk factors, clinical and outcome data and data of antenatal and postnatal treatment of infants with a birth weight below 1,500 g were prospectively recorded. The measures of infants treated with the new method of surfactant application were compared to those of infants who received standard care. The analysis was restricted to infants with a gestational age below 31 weeks (n=1,541).
  
  
  RESULTS
  319 infants were treated with the new method and 1,222 with standard care. The need for mechanical ventilation during the first 72 h (29% vs. 53%, p<0.001), the rate of bronchopulmonary dysplasia defined as oxygen at 36 weeks of postmenstrual age (10.9 % vs. 17.5%, p=0.004) and the rate of death or bronchopulmonary dysplasia were significantly lower in the treatment group than in the standard care group. Surfactant, theophyllin, caffeine and doxapram were significantly more often and analgetics, catecholamines and dexamethasone were significantly less frequently used in the treatment group.
  
  
  CONCLUSIONS
  A new method of surfactant application was associated with a lower prevalence of mechanical ventilation and better pulmonary outcome. A prospective controlled trial is required to determine whether this approach is superior to standard care.
authors.affiliation: Neonatologie, Universitätskinderklinik Köln, Köln, Germany. angela.kribs@uk-koeln.de
authors.forename: Angela
authors.initials: A
authors.lastname: Kribs
authors.forename: C
authors.initials: C
authors.lastname: Härtel
authors.forename: E
authors.initials: E
authors.lastname: Kattner
authors.forename: M
authors.initials: M
authors.lastname: Vochem
authors.forename: H
authors.initials: H
authors.lastname: Küster
authors.forename: J
authors.initials: J
authors.lastname: Möller
authors.forename: D
authors.initials: D
authors.lastname: Müller
authors.forename: H
authors.initials: H
authors.lastname: Segerer
authors.forename: C
authors.initials: C
authors.lastname: Wieg
authors.forename: C
authors.initials: C
authors.lastname: Gebauer
authors.forename: W
authors.initials: W
authors.lastname: Nikischin
authors.forename: A v d
authors.initials: Av
authors.lastname: Wense
authors.forename: E
authors.initials: E
authors.lastname: Herting
authors.forename: B
authors.initials: B
authors.lastname: Roth
authors.forename: W
authors.initials: W
authors.lastname: Göpel
mesh_terms: D001688:Biological Products / Q000008:administration & dosage; D001997:Bronchopulmonary Dysplasia / Q000401:mortality / Q000517:prevention & control; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure; D005260:Female; D005865:Gestational Age; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007322:Instillation, Drug; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D010102:Oxygen Inhalation Therapy; D010743:Phospholipids / Q000008:administration & dosage; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy* / Q000401:mortality; D016019:Survival Analysis
chemical_list: D001688:Biological Products; D010743:Phospholipids; D011663:Pulmonary Surfactants; C078272:SF-RI 1, bovine surfactant preparation; C068291:poractant alfa; C072197:beractant