[Intraamniotic surfactant supply as RDS prevention]

The importance of steroids given antenatally to the mothers in prevention of the respiratory distress syndrome (RDS) is unquestionable. Also intra tracheal surfactant application in newborn is proven method of prevention and treatment of RDS. However both options have some limitations and new methods useful in prevention of RDS are still needed. The aim of the study was to evaluate the efficiency and safety of the procedure of the intraamniotic surfactant supply as RDS prevention. Natural surfactant (Alveofact - Boehringer Ingelheim) has been given to 15 women at 24-32 weeks of pregnancy, two hours before expected childbirth (mainly cesarean section). To 8 of these women corticosteroids have been earlier administered. Just before surfactant injection amniotic liquid samples were taken to confirm lung immaturity and the patients were administered Aminophilline intravenously to provoke fetal breathing movements. Surfactant has been administered through the needle under direct ultrasound guidance into the amniotic cavity as close as possible to the fetal mouth and nose. Patients with the evidence of chorionamnionitis and fetal malformations were excluded from the study. No complications were observed during and after the procedure. None of the newborns had symptoms of severe asphyxia, the birth weight comprised between 670-1650 g (mean 1207). There was radiological evidence of RDS in two newborns and in 7 mechanical ventilation was needed. Of 15 newborns 13 survived (86.6%). There was no need for postpartum surfactant therapy in any case. Some authors expressed their view that this method is promising and further studies are desirable. In our study surfactant has been injected into the amniotic cavity shortly before childbirth, and Aminophilline has been administered intravenously in order to provoke fetal breathing movements before surfactant injection. The safety of the procedure was confirmed and the results of intraamniotic surfactant supply seems to be favourable to newborns. Small number of cases does not allow to draw any far-reaching conclusions. Still our preliminary results are encouraging and the study should be continued.