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Published on: February 5, 2019
Early regular versus late selective poractant treatment in preterm infants born between 25 and 30 gestational weeks:
Uğur Dilmen1, Ramazan Özdemir, Hatice Tatar Aksoy
1Zekai Tahir Burak Maternity and Teaching Hospital, Neonatal Intensive Care Unit , Ankara , Turkey .
Insights
Early surfactant (ES) treatment for preterm infants reduced rates of intraventricular hemorrhage and pneumothorax compared to late selective (LS) treatment. However, ES did not significantly impact bronchopulmonary dysplasia rates or overall mortality.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Neonatal Intensive Care
Background:
- Surfactant replacement therapy is crucial for preterm infants.
- Early surfactant administration may improve neonatal outcomes.
- Comparing early versus late selective surfactant treatment is essential for optimizing care.
Purpose of the Study:
- To compare the effects of early surfactant (ES) administration versus late selective (LS) treatment on neonatal outcomes in preterm infants.
- To evaluate the impact of ES versus LS on mechanical ventilation, respiratory support duration, and major neonatal morbidities.
Main Methods:
- Randomized controlled trial involving preterm infants (25-30 weeks gestational age).
- Infants were randomized to receive Curosurf® either within 1 hour (ES) or within 6 hours (LS) of birth.
- Outcomes included rates of BPD, ROP, mortality, pneumothorax, PDA, NEC, and IVH (≥ grade III).
Main Results:
- No significant differences were observed in the rates of mechanical ventilation, nCPAP duration, oxygen requirement duration, PDA, NEC, BPD, ROP stage >3, or mortality between the ES and LS groups.
- The ES group demonstrated significantly lower rates of pneumothorax and intraventricular hemorrhage (IVH) ≥ grade III compared to the LS group.
- Forty-four percent of infants in the LS group required surfactant, while 8.9% in the ES group needed a second dose.
Conclusions:
- Early surfactant (ES) administration in preterm infants is associated with reduced rates of intraventricular hemorrhage (IVH) and pneumothorax.
- ES treatment does not appear to affect the rates of bronchopulmonary dysplasia (BPD) when compared to late selective (LS) treatment.
- The findings suggest potential benefits of early surfactant administration for specific morbidities in preterm neonates.
Objective:
Surfactant treatment in the early hours of life significantly decreases the rates of death and air leak, and increases survival without bronchopulmonary dysplasia (BPD) in preterm infants. We aimed to compare the impact of early surfactant (ES) administration to late selective (LS) treatment on neonatal outcomes in preterm infants.
Methods:
All preterm infants between 25 and 30 wks gestational age and who were not entubated in the delivery room and did not have any major congenital malformation or perinatal asphyxia were randomized to ES treatment (200 mg/kg Curosurf® administration in 1 hour after birth) or LS treatment (200 mg/kg Curosurf®administration in the first 6 h of life if needed). The patients were treated by nasal continuous positive airway pressure (nCPAP) treatment regardless of the surfactant requirement. Outcomes were the necessity of mechanical ventilation, nCPAP duration, the oxygen requirement duration, the rates of BPD, retinopathy of prematurity (ROP) and mortality, and the assessment of the following situations; (pneumothorax, patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH) ≥ grade III).
Results:
Among 159 infants enrolled in the study, 79 were randomized to ES and 80 to LS treatment groups. Thirty-five patients (44%) in the LS treatment group needed surfactant administration. Necessity of second dose surfactant administration was 8.9% in the ES treatment group. Although necessity of mechanical ventilation, nCPAP duration, oxygen need duration, rates of PDA, NEC, BPD, ROP stage >3 and mortality did not show a significant difference between groups, the ES treatment group had lower rates of pneumothorax and IVH ≥ grade III when compared to the LS treatment group.
Conclusions:
ES treatment decreases IVH (≥ grade III) and pneumothorax rates but does not have any effect on BPD when compared to LS.