Surfactant use based on the oxygenation response to lung recruitment during HFOV in VLBW infants.
OBJECTIVE
Early lung recruitment (ELR) during high-frequency oscillatory ventilation (HFOV) in combination with prophylactic surfactant use has been reported to reduce mortality, improve respiratory outcomes, and reduce the need for repeated surfactant dosing, suggesting that surfactant might be used more selectively in very low birth weight (VLBW) infants on HFOV than generally recommended. We report our first experience from such a selective early rescue use of surfactant in VLBW infants on HFOV.


METHODS
After a deliberate ELR maneuver and "optimal" continuous distending pressure (CDP) finding during HFOV, used as primary ventilation mode for VLBW infants with respiratory distress syndrome (RDS), surfactant was only given when an unsatisfactory oxygenation response to lung recruitment (as defined by CDP x FiO(2) > 5) was observed.


RESULTS
Out of 144 VLBW infants on HFOV, 84 (58.3%) received surfactant and 60 (41.7%) did not. Duration of required oxygen supplementation (37.4 +/- 44.9 vs. 46.2 +/- 35.4 days; P = 0.031) and respiratory support (i.e., n-CPAP and/or mechanical ventilation; 22.3 +/- 19.3 vs. 38.2 +/- 24.3 days; P = 0.001) was shorter for infants who did not receive surfactant than for those who did. The incidence and severity of bronchopulmonary dysplasia was similar in both groups, and there was no difference in survival rates between groups. Subgroup analysis for infants of less than 28 weeks of gestation revealed similar results.


CONCLUSIONS
First intention HFOV combined with an early attempt at lung volume optimization might allow surfactants to be used more selectively (in relation to disease severity) in VLBW infants presenting with RDS at birth without negatively influencing the outcome.
Division of Pediatric and Neonatal Intensive Care, Department of Pediatrics, University Hospital of Geneva, 6, Rue Willy Donzé, 1211, Geneva 14, Switzerland.
Pierre
P
Tissières
Patrick
P
Myers
Maurice
M
Beghetti
Michel
M
Berner
Peter C
PC
Rimensberger
D045422:Continuous Positive Airway Pressure / Q000379:methods*; D004374:Ductus Arteriosus, Patent; D006612:High-Frequency Ventilation / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000628:therapy
D011663:Pulmonary Surfactants