Does timing of initial surfactant treatment make a difference in rates of chronic lung disease or mortality in premature infants? An observational regional study.
OBJECTIVE
To compare two treatment strategies in preterm infants with or at risk of respiratory distress syndrome: early surfactant administration (within one hour of birth) versus late surfactant administration, in a geographically defined population.


RESULTS
The primary outcome was chronic lung disease (CLD) and mortality before/at 36 weeks. Secondary outcomes included: duration of mechanical ventilation and continuous positive airway pressure (CPAP), post-natal steroids for CLD and major neonatal morbidities.


METHODS
Premature infants born at 22-32 weeks' gestation between January 2006 and December 2009.


METHODS
Ten neonatal intensive care units (NICUs) in New South Wales (NSW) and Australian Capital Territory (ACT), Australia.


METHODS
Retrospective analysis of prospectively collected data from the regional NICU database in NSW and ACT.


RESULTS
Of the 2170 infants who received surfactant, 1182 (54.5%) and 988 (45.5%) received early and late surfactant, respectively. The early surfactant group was less mature (27.1 ± 2.1 versus 29.4 ± 2.1 weeks) and had more CLD and mortality (40.2% versus 20.0%). The multivariable analysis showed early surfactant to be associated with less duration of ventilation, longer duration of CPAP and longer hospital stay but had little or no impact on CLD/mortality.


CONCLUSIONS
Early surfactant administration is associated with shorter duration of ventilation but does not appear to be significantly protective against CLD/mortality among premature infants. This may support the growing evidence for consideration of CPAP as an alternative to routine intubation and early surfactant administration. Further investigation from large randomized clinical trials is warranted to confirm these results.
a Department of Internal Medicine .
Daphne
D
Premnath
b Department of Neonatology , Canberra Hospital , Garran , ACT , Australia .|c The Clinical School, Australian National University , Garran , ACT , Australia .
Alison Louise
AL
Kent
d Neonatal Intensive Care Units' (NICUS) Data Collection, NSW Pregnancy and Newborn Services Network , NSW , Australia , and.|e School of Public Health, University of Sydney , NSW , Australia.
Barbara
B
Bajuk
b Department of Neonatology , Canberra Hospital , Garran , ACT , Australia .|c The Clinical School, Australian National University , Garran , ACT , Australia .
Mohamed E
ME
Abdel-Latif
D020958:Australian Capital Territory / Q000453:epidemiology; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome
D011663:Pulmonary Surfactants
Chronic lung disease; low birth weight; mortality; premature; preterm; surfactant; survival