Biparametric score as a new tool for early indication of surfactant in preterm infants

To investigate whether the use of a biparametric score, based on lung ultrasound (LUS) and oxygen saturation/fraction of inspired oxygen ratio (SF ratio), in preterm infants with respiratory distress syndrome (RDS) allows earlier surfactant therapy (first 3 hours of life) compared to classic FiO₂ criteria.

Before-after design study, performed in a tertiary neonatal intensive care unit. Inclusion criteria were newborns with gestational age < 34 weeks with clinical RDS and respiratory support with noninvasive ventilation. The patients were divided into two groups, the control group, with surfactant indication according to classic criteria, collected retrospectively, and the new protocol group, with surfactant criteria according to biparametric score.

61 patients were included. The new protocol group received surfactant earlier (all patients in the first 3 hours, p 0.013). Likewise, after surfactant treatment, newborns in this group required lower FiO₂ (p 0.001) and a better pulmonary ultrasound evolution according to LUS (p 0.008).

Biparametric scoring allowed earlier surfactant therapy and reduced post-treatment oxygen requirement. This protocol offers a more personalized approach tailored to the patient's needs, which helps us in decision-making.