Intra-amniotic instillation of surfactants for the prevention of neonatal respiratory distress syndrome following preterm delivery.
OBJECTIVE
To assess the efficacy of intra-amniotic administration of surfactants in reducing the incidence and severity of respiratory distress syndrome (RDS), and the need for postnatal endotracheal surfactant during preterm delivery.


METHODS
A prospective pilot study enrolled pregnant women at 28-34 weeks of pregnancy between July 1, 2013 and December 31, 2014 who were randomly assigned in a 1:1 ratio to a control group or to receive intra-amniotic surfactant (3mL) administered under ultrasonography guidance within 2-8 hours of expected delivery. The primary outcomes, the incidence and severity of RDS, and the need for postnatal surfactants, were analyzed on an intention-to-treat basis.


RESULTS
The study enrolled 20 patients to each group. The incidence of RDS did not differ between the two groups (P=0.110). Severe RDS was more common in the control group (P=0.018) and postnatal surfactants were required more frequently in the control group (P=0.02).


CONCLUSIONS
Intra-amniotic administration of surfactants reduced RDS severity and the need for postpartum endotracheal surfactants. Clinical Trials Registry India: CTRI/2015/12/006399.
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: nutan.agarwal1@gmail.com.
Nutan
N
Agarwal
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
Shikha
S
Bathwal
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
Alka
A
Kriplani
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Ashok
A
Deorari
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
Neerja
N
Bhatla
D000328:Adult; D000650:Amnion; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India; D007267:Injections; D008875:Middle Aged; D010865:Pilot Projects; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000188:drug therapy*; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000517:prevention & control*; D012720:Severity of Illness Index; D014463:Ultrasonography; D055815:Young Adult
D011663:Pulmonary Surfactants
Intra-amniotic; Preterm birth; Respiratory distress syndrome; Surfactant