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[Surfactant replacement therapy for respiratory distress syndrome: a pilot study]
E S Shinwell1, E Zmora, D Leven
1Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheba.
Insights
Exogenous surfactant (ES) significantly improved oxygenation and reduced respiratory distress syndrome (RDS) complications in premature infants. This pilot study showed lower mortality and fewer air leaks in treated infants compared to controls.
Area of Science:
- Neonatology
- Pulmonology
- Pediatric Critical Care
Context:
- Respiratory Distress Syndrome (RDS) is a common and serious condition in premature infants.
- Current management often involves supportive care, including mechanical ventilation.
- The potential benefit of exogenous surfactant replacement therapy in RDS requires further investigation.
Purpose:
- To evaluate the efficacy and safety of exogenous surfactant (ES) in premature infants with RDS.
- To compare outcomes in infants treated with natural surfactant (Curosurf) against a historical control group.
Summary:
- A pilot study administered 200 mg/kg of Curosurf to 15 premature infants with RDS.
- Treated infants demonstrated rapid oxygenation improvement, reduced ventilatory needs, and a 169% increase in the arterial/alveolar ratio.
- No pulmonary air leaks occurred in the ES group, unlike 21% in controls; mortality was halved (13% vs 27%, p<0.01).
Impact:
- Exogenous surfactant therapy shows promise in significantly improving respiratory outcomes for premature infants with RDS.
- This treatment may reduce the incidence of serious complications like pneumothorax and lower overall mortality rates.
- Further research is warranted to optimize surfactant dosage, timing, and composition for ideal therapeutic effects.
Abstract:
A pilot study of the effect of exogenous surfactant (ES) on premature infants with respiratory distress syndrome (RDS) is reported. Each of the first 15 infants in this study received 200 mg/kg of natural surfactant (Curosurf) during the first day of life. Controls were 56 infants with RDS seen in the 15 months prior to the study. Within 5 minutes of starting ES, in all infants there was rapid and dramatic improvement in oxygenation and improvement in the average arterial/alveolar ratio of 169%. They had lower oxygen and ventilatory requirements than the control group throughout the first 5 days of life. No treated infant suffered from pulmonary air leak, while in the control group 21% developed pneumothorax and 11% had pulmonary interstitial emphysema. Mortality was 13% in the treated group as compared to 27% in the control group (p less than 0.01). There were no differences between the groups in the incidence of sepsis, patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, or bronchopulmonary dysplasia, nor were there side-effects of therapy. Dosage, timing and composition of the ideal surfactant are important questions for future studies.