title: Surfactant Need by Gestation for Very Preterm Babies Initiated on Early Nasal CPAP: A Danish Observational Multicentre Study of 6,628 Infants Born 2000-2013.
abstract: In recent years, early nasal continuous positive airway pressure (nCPAP) as respiratory support for preterm infants is being advocated as an alternative to prophylactic surfactant and treatment with mechanical ventilation. A number of infants treated with early nCPAP do not need treatment with surfactant, but few studies provide data on this. Since the 1990s, the first approach to respiratory support to preterm infants in Denmark has been early nCPAP combined with surfactant administration by the INSURE method by which the infant is intubated and surfactant administration is followed by rapid extubation to nCPAP if possible.
  
  
  
  To investigate how often surfactant was administered in preterm infants with a gestational age below 34 weeks treated with early nCPAP as a first approach to respiratory support.
  
  
  
  An observational multicentre study including all inborn infants with a gestational age below 34 weeks admitted to 1 of the 4 level 3 neonatal intensive care units in Denmark in the period from 2000 to 2013.
  
  
  
  A total of 6,628 infants were included in this study. We found that surfactant was administered in 1,056 of 1,799 (59%; 95% CI: 57-61%), in 821 of 2,864 (29%; 95% CI: 27-31%), and in 132 of 1,796 (7%; 95% CI: 6-8%) of the infants with a gestational age from 24 to 27, 28 to 31, and 32 to 33 weeks and 6 days, respectively.
  
  
  
  A large proportion of preterm infants treated with early nCPAP as the first approach to respiratory support was never treated with surfactant.
authors.affiliation: Department of Paediatrics, Herlev Hospital, Herlev, Denmark.
authors.forename: Rikke
authors.initials: R
authors.lastname: Wiingreen
authors.forename: Gorm
authors.initials: G
authors.lastname: Greisen
authors.forename: Finn
authors.initials: F
authors.lastname: Ebbesen
authors.forename: Jesper Padkær
authors.initials: JP
authors.lastname: Petersen
authors.forename: Gitte
authors.initials: G
authors.lastname: Zachariassen
authors.forename: Tine Brink
authors.initials: TB
authors.lastname: Henriksen
authors.forename: Bo
authors.initials: B
authors.lastname: Mølholm Hansen
mesh_terms: D045422:Continuous Positive Airway Pressure; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D008297:Male; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D015996:Survival Rate
chemical_list: D011663:Pulmonary Surfactants
keywords: Early nasal CPAP; INSURE; Preterm infant; Respiratory distress syndrome; Surfactant