Related Experiment Videos
Early versus late surfactant replacement therapy in severe respiratory distress syndrome
C P Speer1, K Harms, E Herting
1Department of Pediatrics, University of Göttingen, Federal Republic of Germany.
Insights
Early surfactant replacement therapy for severe respiratory distress syndrome (RDS) in preterm infants improves outcomes. Prompt treatment with natural porcine surfactant (Curosurf) reduces the risk of bronchopulmonary dysplasia (BPD) and mortality.
Area of Science:
- Neonatal Medicine
- Pulmonology
- Pediatric Critical Care
Background:
- Severe respiratory distress syndrome (RDS) poses significant risks to preterm infants.
- Artificial ventilation and high oxygen concentrations are often required for severe RDS.
- Surfactant replacement therapy is a key intervention for RDS.
Purpose of the Study:
- To evaluate the efficacy of early versus late surfactant replacement therapy in preterm infants with severe RDS.
- To compare outcomes including oxygenation, ventilation duration, and incidence of bronchopulmonary dysplasia (BPD).
Main Methods:
- A study of 26 preterm infants with severe RDS (grade III-IV) treated with natural porcine surfactant (Curosurf, 200 mg/kg).
- Infants were divided into early treatment (2-15 h) and late treatment (>15-48 h) groups.
- Clinical and radiological signs, oxygenation (PaO2/FiO2 ratio), ventilation requirements, and BPD incidence were monitored.
Main Results:
- Both early and late treatment improved oxygenation within 5 minutes.
- Early treatment group had shorter ventilation duration (15 days vs. 19 days) and less oxygen exposure (21 days vs. 48 days).
- No pneumothorax occurred; all early-treated infants survived without severe BPD, while two late-treated infants developed severe BPD, and one died.
Conclusions:
- Early initiation of surfactant replacement therapy is crucial for managing severe RDS in preterm infants.
- Prompt treatment with Curosurf can significantly reduce the incidence of severe bronchopulmonary dysplasia and improve survival rates.
- Surfactant therapy should be administered as soon as possible after the onset of severe RDS.
Abstract:
26 preterm infants with severe respiratory distress syndrome (RDS) have been treated at different ages with a single dose of natural porcine surfactant (Curosurf, 200 mg/kg). Criteria for treatment included clinical and radiological signs of severe RDS (grade III-IV), requirement of artificial ventilation and an FiO2 greater than or equal to 0.6. Nineteen neonates have been subjected to early treatment (2-15 h of age, mean birth weight SD: 1201 +/- 387 g) and 7 patients to late treatment (greater than 15 h to 48 h of age, birth weight SD 1624 +/- 649 g). Average FiO2 before treatment was 0.88 in early-treated patients and 0.8 in late-treated patients, age at treatment was 4.6 h and 36 h, respectively (median). Both early- and late-treated infants exhibited an improvement in oxygenation (more than twofold increase of the PaO2/FiO2 ratio) within 5 minutes after initiation of therapy. Average duration of intermittent pressure ventilation was 15 days in the early treatment group and 19 days in the late treatment group. Total exposition to greater than 21% oxygen was 21 days in early-treated and 48 days in late-treated infants. Pneumothorax occurred in none of the patients. All early treated infants survived without signs of severe bronchopulmonary dysplasia (BPD greater than 21% O2, greater than 90 days plus radiological changes). However, two out of seven late-treated infants developed severe BPD; one patient died as a consequence of cardiopulmonary deterioration. Two patients in the early treatment group died of nonpulmonary complications. We conclude that surfactant replacement therapy should probably be initiated as soon as possible after manifestation of severe RDS.