Respiratory distress syndrome in Curaçao. Conventional versus surfactant treatment

The aim of this study was to determine the incidence of Respiratory Distress Syndrome (RDS) and to evaluate the efficacy of surfactant treatment at the Neonatal Intensive Care Unit (NICU) at the St Elisabeth Hospital, Curaçao, Netherlands, Antilles. This was a retrospective cohort study of 86 infants, with moderate to severe RDS, out of 877 newborns admitted to the NICU between 1991 and 1998. Results of conventional RDS treatment between 1991 and 1994 (n = 54, group 1) were compared to results of treatment between 1994 and 1998 (n = 32, group 2) with surfactant and increased prenatal steroids. The incidence of RDS in group 1 was 12%, and 7.5% in group 2. Use of prenatal steroids increased from 7.3% (group 1) to 47% in group 2 (p < 0.05). Twenty-five infants died, 17 (31.5%) in group 1 and 8 (25%) in group 2. The complication most frequently found in both study groups was Bronchopulmonary Dysplasia (BPD): sixteen infants (30%) in group 1 and 9 infants (28%) in the surfactant-treated group. BPD was significantly associated with time on the ventilator in both groups (p < 0.05). We found no cases (0%) of Retinopathy of Prematurity (ROP) in group 1, and 3 cases (9%, p < 0.05) in group 2. We found no differences in other complications between group 1 and 2. The mean time between birth and the first surfactant treatment in group 2 was more than nine hours. Surfactant rescue treatment in combination with prenatal steroids results in lower incidence of RDS and in lower mortality than conventional RDS treatment in this study. The increased incidence of ROP in the surfactant-treated group was probably the result of better detection. BPD and other complications remained unchanged. Earlier surfactant administration is suggested to reduce mortality and morbidity in the future.