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Very early surfactant without mandatory ventilation in premature infants treated with early continuous positive

Mario Augusto Rojas1, Juan Manuel Lozano, Maria Ximena Rojas

  • 1Vanderbilt University, Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Nashville, TN 37232-2370, USA. mario.a.rojas@vanderbilt.edu

Pediatrics
|January 2, 2009
PubMed

Insights

Very early surfactant therapy in premature infants receiving nasal continuous positive airway pressure reduces the need for mechanical ventilation and air-leak syndrome. This approach is safe and may decrease chronic lung disease in neonates.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Critical Care

Background:

  • Chronic lung disease is a major complication of premature birth, often linked to mechanical ventilation.
  • Nasal continuous positive airway pressure (nCPAP) is used to avoid mechanical ventilation in premature infants.
  • Surfactant therapy, typically for ventilated infants, may benefit those receiving nCPAP.

Purpose of the Study:

  • To assess if very early surfactant therapy without mandatory ventilation improves outcomes in premature infants on nCPAP.
  • To determine if this strategy reduces the need for mechanical ventilation in very premature infants.

Main Methods:

  • A randomized, controlled trial involving 279 infants (27-31 weeks gestation) across eight centers.
  • Infants received either nCPAP alone (control) or nCPAP with brief intubation for very early surfactant administration (treatment).
  • The primary outcome was the need for subsequent mechanical ventilation.

Main Results:

  • The treatment group showed a lower need for mechanical ventilation (26% vs. 39%) and less air-leak syndrome (2% vs. 9%).
  • Fewer infants in the treatment group required surfactant after the first hour (12% vs. 26%).
  • Chronic lung disease incidence was lower in the treatment group (49% vs. 59%), with similar mortality and major morbidities.

Conclusions:

  • Very early surfactant therapy combined with nCPAP is safe and effective in reducing mechanical ventilation needs in premature infants.
  • This intervention decreases air-leak syndrome and shows a trend towards reduced chronic lung disease.
  • The findings are significant for resource-limited settings, potentially improving long-term outcomes for neonates.
Abstract

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