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Calf lung surfactant extract prophylaxis and retinopathy of prematurity
M X Repka1, M L Hudak, C F Parsa
1Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21205-2810.
Insights
Surfactant therapy significantly improved survival and reduced the incidence and severity of Retinopathy of Prematurity (ROP) in extremely low birth weight infants. This treatment shows promise in preventing ROP-related blindness.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Pharmacology
Background:
- Retinopathy of prematurity (ROP) is a leading cause of blindness in extremely low birth weight (ELBW) infants.
- Increased survival rates of ELBW infants, partly due to surfactant therapy for respiratory distress syndrome, necessitate understanding its impact on ROP.
- Limited research exists on the effect of surfactant therapy on ROP incidence and severity.
Purpose of the Study:
- To evaluate the effect of prophylactic calf lung surfactant extract (Infasurf) on the incidence and severity of ROP in ELBW infants.
- To assess the impact of surfactant therapy on survival rates in ELBW infants.
Main Methods:
- Retrospective review of ELBW infant records from two 2-year intervals before and after surfactant therapy implementation.
- Comparison of survival rates and ROP incidence between surfactant-treated and control groups.
Main Results:
- Surfactant therapy significantly improved survival to discharge (79% vs. 63%, P=0.01).
- A significant reduction in any stage of ROP was observed in surfactant-treated infants (64% vs. 85%, P<0.004).
- Threshold ROP (Stage 3+) incidence was substantially reduced (3.4% vs. 10%, P=0.16).
Conclusions:
- Prophylactic Infasurf administration is associated with improved survival and reduced ROP incidence and severity in ELBW infants.
- The beneficial effect of surfactant on ROP was consistent across various infant demographics.
- Infasurf shows potential for substantially decreasing ROP in the extremely low birth weight population.
Abstract:
Retinopathy of prematurity (ROP) is an important cause of blindness among extremely low birth weight infants (birth weight less than or equal to 1000 g). In the 1990s, greater numbers of extremely low birth weight infants will survive, in part due to routine surfactant replacement therapy for neonatal respiratory distress syndrome. Few studies have evaluated the effect of surfactant therapy on the incidence and severity of ROP. The authors performed a review of the records of extremely low birth weight infants born in two 2-year intervals before and after initiation of a clinical protocol in which all extremely low birth weight infants received prophylactic treatment with calf lung surfactant extract (Infasurf). Surfactant therapy was associated with a significant improvement in survival to discharge (79% [88 of 112] versus 63% [82 of 131]; P = 0.01). Compared with control infants, surfactant-treated infants had a significantly lower incidence of any stage of ROP (64% [56 of 87] versus 85% [68 of 80]; P less than 0.004). The incidence of threshold (Stage 3 plus or greater) ROP was substantially reduced (3.4% [3 of 87] versus 10% [8 of 80]; P = 0.16)). The surfactant-associated reduction in ROP was independent of birth weight, gestational age, race, or sex. These data suggest that Infasurf may substantially reduce the incidence and severity of ROP in the extremely low birth weight population.