title: Early routine versus late selective surfactant in preterm neonates with respiratory distress syndrome on nasal continuous positive airway pressure: a randomized controlled trial.
abstract: BACKGROUND
  Preterm neonates with respiratory distress syndrome (RDS) benefit from early application of nasal continuous positive airway pressure (nCPAP). However, it is not clear whether surfactant should be administered early as a routine to all such infants or later in a selective manner.
  
  
  OBJECTIVE
  It was the aim of this study to compare the efficacy of early routine versus late selective surfactant treatment in reducing the need for mechanical ventilation (MV) during the first week of life among moderate-sized preterm infants with RDS being supported by nCPAP.
  
  
  METHODS
  Infants born at 28(0/7) to 33(6/7) weeks of gestation with RDS and on nCPAP were randomly assigned within the first 2 h of life to early routine surfactant administration by the InSurE technique (early surfactant group) or to late selective administration of surfactant (late surfactant group). The primary outcome was need for MV in the first 7 days of life.
  
  
  RESULTS
  Among 153 infants randomized to early (n = 74) or late surfactant (n = 79) groups, the need for MV was significantly lower in the early surfactant group (16.2 vs. 31.6%; relative risk 0.41, 95% confidence interval 0.19-0.91). The incidence of pneumothorax (1.9 vs. 2.3%) and the need for supplemental O2 at 28 days (2.7 vs. 8.9%) were similar in the two groups.
  
  
  CONCLUSIONS
  Early routine surfactant administration within 2 h of life as compared to late selective administration significantly reduced the need for MV in the first week of life among preterm infants with RDS on nCPAP.
authors.affiliation: Department of Neonatology, Fernandez Hospital, Hyderabad, India.
authors.forename: Hemasree
authors.initials: H
authors.lastname: Kandraju
authors.forename: Srinivas
authors.initials: S
authors.lastname: Murki
authors.forename: Sreeram
authors.initials: S
authors.lastname: Subramanian
authors.forename: Pramod
authors.initials: P
authors.lastname: Gaddam
authors.forename: Ashok
authors.initials: A
authors.lastname: Deorari
authors.forename: Praveen
authors.initials: P
authors.lastname: Kumar
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000009:adverse effects; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D015931:Intensive Care, Neonatal; D008297:Male; D011663:Pulmonary Surfactants / Q000008:administration & dosage* / Q000009:adverse effects; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011663:Pulmonary Surfactants