title: Bovine Surfactant Replacement Therapy in Neonates of Less than 32 Weeks' Gestation: A Multicenter Controlled Trial of Prophylaxis versus Early Treatment in China--a Pilot Study.
abstract: BACKGROUND
  A domestic surfactant preparation has been used in China for a number of years. However, as for other surfactant preparations, there is debate among neonatologists regarding the optimal dose, mode of administration, and the best time of intervention.
  
  
  OBJECTIVE
  To evaluate whether prophylactic administration of surfactant is superior to early treatment in preterm infants < 32 weeks with a high risk of respiratory distress syndrome (RDS).
  
  
  METHODS
  We prospectively compared small premature infants (< 32 weeks) receiving 70 mg/kg bovine surfactant within 30 minutes after birth (prophylactic group, N = 116) with infants who received surfactant therapy for established RDS (early treatment group, N = 91). The primary outcome assessed was the incidence of RDS. The secondary outcomes assessed were severity of RDS, mortality, and bronchopulmonary dysplasia morbidity.
  
  
  RESULTS
  Compared with the early treatment group, the prophylactic group had a significantly better PaO2 (at 1 hour, 4 hours, and 12 hours postdose, respectively), better a/APO2 (at 1 hour, 4 hours, 12 hours, and 24 hours postdose, respectively), lower PaCO2 (at 1 hour postdose), and a significantly decreased need for mean airway pressure (MAP) and FiO2 on ventilation (p < 0.05). The prophylactic group had shorter durations for mechanical ventilation and supplemental oxygen compared with the early treatment group (p < 0.01 and p < 0.05, respectively). The incidence of RDS was comparable between the groups; however, the prophylactic group had a significantly lower incidence of severe RDS and significantly lower rate of repeated doses of surfactant than the early treatment group (p < 0.05). The incidences of bronchopulmonary dysplasia and patent ductus arteriosus were also lower in the prophylactic group than the early treatment group (p < 0.05). The two groups were comparable in mortality rate.
  
  
  CONCLUSIONS
  In preterm infants under 32 weeks' gestation, prophylactic use of a domestic surfactant preparation is better than early surfactant treatment in improving pulmonary status and in decreasing the incidence of severe RDS and duration on mechanical ventilation.
authors.affiliation: Newborn Care Center, Bayi Children's Hospital, the Military General Hospital of Beijing P.L.A., Beijing, China.
authors.forename: Xiangyong
authors.initials: X
authors.lastname: Kong
authors.affiliation: Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Qiliang
authors.initials: Q
authors.lastname: Cui
authors.affiliation: Department of Pediatrics, Jiangsu Province Hospital, Nanjing, China.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Pediatrics, Nanfang Hospital, Nanfang Medical University, Guangzhou, China.
authors.forename: Weimin
authors.initials: W
authors.lastname: Huang
authors.affiliation: Newborn Care Center, Chengdu Women's and Children's Central Hospital, Chengdu, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Ju
authors.affiliation: Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Li
authors.affiliation: Newborn Care Center, Bayi Children's Hospital, the Military General Hospital of Beijing P.L.A., Beijing, China.
authors.forename: Ruijuan
authors.initials: R
authors.lastname: Wang
authors.affiliation: Department of Pediatrics, Hospital of Hubei Province, Wuhan, China.
authors.forename: Shiwen
authors.initials: S
authors.lastname: Xia
authors.affiliation: Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Jialin
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Neonatology, Daping Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Tian
authors.initials: T
authors.lastname: Zhu
authors.affiliation: Newborn Care Center, Bayi Children's Hospital, the Military General Hospital of Beijing P.L.A., Beijing, China. Electronic address: zhjfengzc@126.com.
authors.forename: Zhichun
authors.initials: Z
authors.lastname: Feng
mesh_terms: D000818:Animals; D002417:Cattle; D045422:Continuous Positive Airway Pressure; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010100:Oxygen / Q000097:blood; D010865:Pilot Projects; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012127:Respiratory Distress Syndrome, Newborn / Q000517:prevention & control*
chemical_list: D011663:Pulmonary Surfactants; D010100:Oxygen
keywords: bovine surfactant; premature infants; prophylactic administration; respiratory distress syndrome