Early surfactant guided by lamellar body counts on gastric aspirate in very preterm infants.
BACKGROUND
We have developed a rapid method, based on lamellar body counts (LBC) on gastric aspirate, for identifying newborns who will develop respiratory distress syndrome with a need for surfactant supplementation.


OBJECTIVE
We set out to test whether it was possible to improve the outcome when used in a clinical trial.


METHODS
We randomly assigned 380 infants born at 24-29 weeks' gestation and supported with nasal continuous positive airway pressure (nCPAP) to receive surfactant guided either by LBC (intervention group) or increasing need for oxygen (control group). The primary outcome was mechanical ventilation or death within 5 days. Secondary outcomes included need for oxygen expressed by arterial to alveolar oxygen tension ratio (a/APO2) at the age of 6 h and need for oxygen at day 28.


RESULTS
The primary outcomes were equal (25%) in the two groups. The intervention group had higher a/APO2 than the control group at 6 h, median 0.64 versus 0.52 (p < 0.01), and the subgroup with gestational age 26-29 weeks needed fewer days of oxygen supplementation than the controls, median 2 vs. 9 days (p = 0.01), and fewer infants needed oxygen at day 28 (p = 0.04). Furthermore, there was a tendency in the intervention group towards a shorter duration of nCPAP. Too little or viscose aspirate in 23% of the cases was a limitation of the method.


CONCLUSIONS
Using LBC test as indicator of lung maturity and early surfactant therapy in very preterm newborns, it is possible to reduce the need for oxygen supplementation.
Department of Pediatrics, Holbæk Hospital, Holbæk, Denmark. hav@regionsjaelland.dk
Henrik
H
Verder
Finn
F
Ebbesen
Jesper
J
Fenger-Grøn
Tine Brink
TB
Henriksen
Bengt
B
Andreasson
Lars
L
Bender
Aksel
A
Bertelsen
Lars J
LJ
Björklund
Marianne
M
Dahl
Gitte
G
Esberg
Christian
C
Eschen
Marie
M
Høvring
Andreas
A
Kreft
Jørn
J
Kroner
Fredrik
F
Lundberg
Pernille
P
Pedersen
Jes
J
Reinholdt
Hristo
H
Stanchev
D001826:Body Fluids / Q000166:cytology*; D016009:Chi-Square Distribution; D045422:Continuous Positive Airway Pressure; D003718:Denmark; D004334:Drug Administration Schedule; D005260:Female; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D016017:Odds Ratio; D015388:Organelles; D010102:Oxygen Inhalation Therapy; D011237:Predictive Value of Tests; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D013396:Suction; D013997:Time Factors; D016896:Treatment Outcome
D011663:Pulmonary Surfactants