Neurodevelopmental outcome and pulmonary morbidity two years after early versus late surfactant treatment: does it...

Area of Science:

• Neonatal Medicine
• Pediatric Pulmonology
• Developmental Pediatrics

Background:

• Respiratory distress syndrome (RDS) is a common condition in preterm infants.
• Surfactant replacement therapy is a cornerstone in managing RDS.
• The optimal timing for surfactant administration remains a subject of investigation.

Purpose of the Study:

• To compare neurodevelopmental outcomes and pulmonary morbidity at two years of age.
• To evaluate the effects of early versus late surfactant treatment in intubated preterm infants with severe RDS.

Main Methods:

• A controlled trial involving 185 preterm infants (27-32 weeks gestation) receiving either early or late surfactant treatment.
• Standardized follow-up included medical history, pulmonary morbidity assessment, and neurodevelopmental evaluation using the Griffiths scales at two years.
• Groups were defined by surfactant administration time: early (31 ± 19 min) versus late (202 ± 80 min) after intubation.

Main Results:

• Neurobehavioral and motor development were comparable between early and late surfactant treatment groups.
• Medical history and actual morbidity at follow-up did not differ significantly.
• The early treatment group showed a delay in the 'personal social' subscale of the Griffiths test and a higher rate of increased muscular tone.

Conclusions:

• Immediate surfactant administration after intubation in preterm infants with RDS offers no clear long-term advantage in morbidity or neurological development.
• These findings support a strategy of awaiting improvement in gas exchange before administering surfactant.
• The results align with previous findings on morbidity at discharge, suggesting a conservative approach to surfactant timing.