title: Prophylactic or early selective surfactant combined with nCPAP in very preterm infants.
abstract: OBJECTIVE
  Early surfactant followed by extubation to nasal continuous positive airway pressure (nCPAP) compared with later surfactant and mechanical ventilation (MV) reduce the need for MV, air leaks, and bronchopulmonary dysplasia. This randomized, controlled trial investigated whether prophylactic surfactant followed by nCPAP compared with early nCPAP application with early selective surfactant would reduce the need for MV in the first 5 days of life.
  
  
  METHODS
  A total of 208 inborn infants who were born at 25 to 28 weeks' gestation and were not intubated at birth were randomly assigned to prophylactic surfactant or nCPAP within 30 minutes of birth. Outcomes were assessed within the first 5 days of life and until death or discharge of the infants from hospital.
  
  
  RESULTS
  Thirty-three (31.4%) infants in the prophylactic surfactant group needed MV in the first 5 days of life compared with 34 (33.0%) in the nCPAP group (risk ratio: 0.95 [95% confidence interval: 0.64-1.41]; P = .80). Death and type of survival at 28 days of life and 36 weeks' postmenstrual age and incidence of main morbidities of prematurity (secondary outcomes) were similar in the 2 groups. A total of 78.1% of infants in the prophylactic surfactant group and 78.6% in the nCPAP group survived in room air at 36 weeks' postmenstrual age.
  
  
  CONCLUSIONS
  Prophylactic surfactant was not superior to nCPAP and early selective surfactant in decreasing the need for MV in the first 5 days of life and the incidence of main morbidities of prematurity in spontaneously breathing very preterm infants on nCPAP.
authors.affiliation: Dipartimento Materno-Infantile, Ospedale Maggiore, Bologna, Italy. f.sandri@ausl.bologna.it
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Sandri
authors.forename: Richard
authors.initials: R
authors.lastname: Plavka
authors.forename: Gina
authors.initials: G
authors.lastname: Ancora
authors.forename: Umberto
authors.initials: U
authors.lastname: Simeoni
authors.forename: Zbynek
authors.initials: Z
authors.lastname: Stranak
authors.forename: Stefano
authors.initials: S
authors.lastname: Martinelli
authors.forename: Fabio
authors.initials: F
authors.lastname: Mosca
authors.forename: José
authors.initials: J
authors.lastname: Nona
authors.forename: Merran
authors.initials: M
authors.lastname: Thomson
authors.forename: Henrik
authors.initials: H
authors.lastname: Verder
authors.forename: Laura
authors.initials: L
authors.lastname: Fabbri
authors.forename: Henry
authors.initials: H
authors.lastname: Halliday
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control; D045422:Continuous Positive Airway Pressure; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D011663:Pulmonary Surfactants / Q000627:therapeutic use*
chemical_list: D011663:Pulmonary Surfactants