Ductal patency in neonates with respiratory distress syndrome. A randomized surfactant trial

The purpose of this study was to evaluate in a controlled study the effect of exogenous surfactant on various manifestations of ductal patency. Premature infants with respiratory distress syndrome were randomized to receive surfactant (Survanta) (n = 22) or air (n = 14). In neonates receiving surfactant, there was a greater tendency for an audible murmur to develop (13 of 22 vs four of 14). In spite of this, the clinical use of indomethacin was similar for the two groups, 10 (45%) of 22 vs six (43%) of 14. Excluding neonates given indomethacin early, a comparable number of surfactant-treated neonates (9/17 [53%]) vs control neonates (6/12 [50%]) demonstrated spontaneous closure of the ductus within a physiologic time frame (on or before day 4). For the gestational ages studied, the beneficial effects of exogenous surfactant were not associated with either an increased risk for delayed closure of the ductus arteriosus or a greater incidence of indomethacin usage. Utilization of exogenous surfactant does not appear to have an adverse impact on ductal patency.