Related Experiment Videos
The selection of infants for surfactant replacement therapy under conditions of limited financial resources
D E Ballot1, A D Rothberg, V A Davies
1Department of Paediatrics and Child Health, Johannesburg Hospital.
Insights
Surfactant replacement therapy (SRT) for premature infants with moderate to severe hyaline membrane disease (HMD) showed comparable outcomes regardless of treatment timing or necessity. A short observation period did not negatively impact results.
Area of Science:
- Neonatal Medicine
- Respiratory Medicine
- Pediatric Critical Care
Background:
- Surfactant replacement therapy (SRT) is crucial for managing hyaline membrane disease (HMD) in premature infants.
- The high cost of SRT can limit its accessibility in resource-constrained settings.
- Previous survival rates for infants with HMD without SRT were 87%, with a 6.4% incidence of bronchopulmonary dysplasia.
Purpose of the Study:
- To identify infants with HMD who would benefit most from SRT, considering cost and resource limitations.
- To evaluate the impact of delayed SRT administration on infant outcomes.
- To compare outcomes between infants receiving SRT and those not requiring it.
Main Methods:
- A randomized controlled trial involving 78 infants with moderate to severe HMD.
- Infants with severe HMD were randomized to receive SRT at 3-4 hours or 6-8 hours after birth.
- Infants with moderate HMD were observed for a limited period to assess the need for SRT.
Main Results:
- Outcomes were similar between severe HMD infants receiving SRT early versus delayed.
- Two infants (15%) with severe HMD randomized to delayed SRT did not require treatment.
- In moderate HMD, 43% of infants did not require SRT, and outcomes were comparable between SRT and non-SRT groups.
- Infants with moderate HMD had significantly better outcomes than those with severe HMD.
Conclusions:
- A brief observation period to assess illness severity is safe and does not compromise outcomes in infants with moderate to severe HMD.
- Selective use of SRT based on initial assessment and response is feasible and effective.
- Optimizing SRT use is important for resource-limited settings without compromising infant care.
Abstract:
The cost of surfactant replacement therapy (SRT) will restrict its use under conditions of limited health resources. Before the local advent of SRT, infants ventilated for hyaline membrane disease (HMD) had an overall survival rate of 87% and an incidence of bronchopulmonary dysplasia of 6.4%. This, together with the cost of SRT, prompted a study to identify those infants who would benefit the most from SRT. Twenty-two infants assessed as having severe HMD were randomised to receive SRT at 3 - 4 hours (9) or at 6 - 8 hours (13) after birth. Two infants (15%) in the latter group did not require SRT. The outcome of these two groups was the same. Of 56 infants assessed as having moderate HMD, only 24 (43%) qualified for SRT from 6 hours of age. The outcome of the SRT and non-SRT infants was comparable. The group of infants with moderate HMD had a significantly better outcome than those with severe HMD. A limited period of observation to assess the severity of illness did not compromise outcome in this group of 78 infants with moderate to severe HMD.