Related Experiment Videos
[Early selective surfactant treatment--also to very premature infants treated with CPAP?]
Insights
Early surfactant treatment for premature infants with respiratory distress syndrome (RDS) on nasal CPAP can be initiated sooner for many. This approach could reduce overtreatment while improving outcomes for neonates requiring surfactant therapy.
Area of Science:
- Neonatal Medicine
- Respiratory Physiology
- Pharmacology
Context:
- Premature infants born between 24 and 29 weeks gestational age were studied retrospectively.
- Neonatal respiratory distress syndrome (RDS) is a significant concern in preterm infants.
- Current selective surfactant treatment protocols may lead to overtreatment in some cases.
Purpose:
- To evaluate the potential for earlier selective surfactant administration in premature neonates.
- To identify factors associated with delayed surfactant treatment.
- To assess the implications of earlier treatment on overtreatment rates.
Summary:
- A retrospective study of 171 premature neonates on nasal CPAP found that 99 eventually received surfactant.
- Later surfactant treatment was significantly associated with higher oxygen requirements (>30%) at 2 hours and being a non-singleton birth.
- Earlier treatment was feasible for 71% of infants who received surfactant, with a potential overtreatment rate of 18%.
Impact:
- Earlier selective surfactant treatment could be beneficial for a significant proportion of premature infants needing therapy.
- Refining treatment criteria may optimize surfactant use and reduce unnecessary interventions.
- This study highlights the need for precise timing of surfactant administration in neonatal intensive care.
Introduction:
Early selective surfactant treatment of premature infants on mechanical ventilation, defined as treatment of selected children within the first two hours of life, reduces the incidence of complications to neonatal respiratory distress syndrome (RDS) as compared with delayed selective surfactant treatment. Treatment of children judged to be solely at risk of RDS, however, eventually leads to overtreatment in some.
Materials And Methods:
A population of premature neonates born at a gestational age of 24 + 0 to 29 + 6 weeks at Rigshospitalet, were studied retrospectively.
Results:
Of the 171 children supported by nasal continuous positive airway pressure (CPAP) at the age of two hours, 99 were eventually treated with a natural surfactant (Curosurf) at a median age of nine hours. A statistically significant association was found between later surfactant treatment and an oxygen supplement of more than 30% at the age of two hours (chi 2: p < 0.001). Furthermore, there was a statistically significant association between later surfactant treatment and birth as the second twin or second or third triplet (chi 2: p < 0.001). Surprisingly, a gestational age of between 24 + 0 and 27 + 6 weeks, a birth weight less than 1.000 g, and a birth weight less than 80% of that expected was not correlated with later surfactant treatment. Forty-nine per cent of the children treated with surfactant received mechanical ventilation at some time before discharge.
Discussion:
Earlier selective surfactant treatment of premature neonates supported by nasal CPAP with an oxygen supplement of more than 30% at the age of two hours would have been possible in 71 of 99 children needing the surfactant. As a consequence, 13 of 72 children would have been overtreated.