title: STRATEGIES OF USING SURFACTANT: RESULTS OF THE FIRST POLISH NATIONAL SURVEY OF DAILY PRACTICE.
abstract: BACKGROUND
  The efficiency of routine practices in the management of neonatal respiratory distress syndrome (RDS) have never been systematically investigated in Poland.
  
  
  OBJECTIVE
  To evaluate RDS treatment policies and short-term outcomes in neonatal intensive care units (NICUs).
  
  
  METHODS
  We retrospectively analyzed medical records of premature neonates ≤ 32 weeks' gestation, diagnosed with RDS in level-2 and level-3 referral centers. Collected data: comprised clinical variables, antenatal corticosteroids, respiratory support, surfactant (SFT) policies and short-term outcomes.
  
  
  RESULTS
  Data of 987 infants from 53 NICUs were analyzed. The median gestational age was 29 weeks (range 22-32) and birth weight 1190 g (range 340-2860). Infants requiring SFT had significantly lower exposure to antenatal corticosteroids (75%) vs. those managed without SFT (83%, p = 0.006). SFT was given to 59% infants in level-3 NICUs and 40% in level-2. There was significant variability of SFT use between level 2 and level 3 NICU. (9% to 100%). Poractant alfa was most commonly used (97%) in the median initial dose of 170 mg/kg (IQR 120-200). Single application was most frequent (79.8%). SFT administration methods were endotracheal instillation in babies maintained on mechanical ventilation (68.0%), INSURE (27.6%) and minimally-invasive delivery (MIST) 4.4%. Early rescue treatment remained core SFTstrategy (57.4% cases), while prophylaxis accounted for only 13.3% cases.
  
  
  CONCLUSIONS
  There is considerable variation in the frequency of use of surfactant in Polish neonatal centers. Traditional intratracheal instillation with subsequent mechanical ventilation dominates, although newer methods INSURE and MIST are becoming increasingly popular. Early rescue SFT is a predominant strategy, which conforms to current standards. The rate of antenatal corticosteroids remains too low.
authors.forename: Maria Katarzyna
authors.initials: MK
authors.lastname: Borszewska-Kornacka
authors.forename: Marzena
authors.initials: M
authors.lastname: Kostuch
authors.forename: Piotr
authors.initials: P
authors.lastname: Korbal
authors.forename: Paweł
authors.initials: P
authors.lastname: Krajewski
mesh_terms: D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011044:Poland; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012121:Respiration, Artificial / Q000379:methods*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012189:Retrospective Studies; D013501:Surface-Active Agents; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D011663:Pulmonary Surfactants; D013501:Surface-Active Agents