Predicting Surfactant Need at Birth: Failed Validation of a Bedside Method Using Gastric Aspirates

Area of Science:

• Neonatal Medicine
• Clinical Diagnostics
• Biochemistry

Background:

• Respiratory distress syndrome (RDS) is a significant concern in preterm infants.
• Accurate assessment of fetal lung maturity is crucial for managing RDS.
• The lecithin/sphingomyelin (L/S) ratio is a key indicator of lung maturity.

Purpose of the Study:

• To validate a prototype point-of-care (POC) test for the L/S ratio.
• To determine the optimal L/S cut-off for predicting surfactant need in preterm infants (<30 weeks' gestation).
• To assess the clinical feasibility of the POC L/S test using gastric aspirates (GAS).

Main Methods:

• Gastric aspirates (GAS) were collected within 45 minutes of birth from preterm infants.
• A prototype POC L/S test was used for analysis.
• Receiver operating characteristic (ROC) curves were planned to assess diagnostic accuracy for surfactant treatment, but primary outcome reporting is restricted.

Main Results:

• 68 infants were included in the analysis.
• 62% of included infants received rescue surfactant treatment.
• 40% of treated infants received surfactant within 2 hours of life.

Conclusions:

• Validation of the POC L/S test was intended but results cannot be disclosed due to legal restrictions.
• Clinical applicability may be limited by the availability of GAS and the timing of surfactant administration.
• The potential for accelerated treatment using this POC test appears constrained.