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Surfactant prophylaxis and retinopathy of prematurity
M X Repka1, R J Hardy, D L Phelps
1Wilmer Ophthalmologic Institute, Johns Hopkins Hospital, Baltimore, MD 21287-9009.
Insights
Prophylactic surfactant therapy did not alter retinopathy of prematurity rates in low-birth-weight infants. However, reduced mortality means more at-risk infants survive, potentially increasing the absolute number of retinopathy cases.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Pulmonology
Background:
- Exogenous surfactant use reduces mortality and respiratory distress syndrome in low-birth-weight infants.
- The impact of prophylactic surfactant on retinopathy of prematurity (ROP) remains unclear.
Purpose of the Study:
- To investigate the effect of prophylactic surfactant therapy on the incidence and severity of retinopathy of prematurity in extremely low-birth-weight infants.
Main Methods:
- Prospective ophthalmologic examinations were conducted in two neonatal intensive care units.
- Patients were part of randomized trials of prophylactic exogenous mammalian surfactant.
- A control group (no surfactant) and a surfactant-treated group (43 patients each) were compared, with no significant differences in baseline characteristics.
Main Results:
- The incidence and severity of retinopathy of prematurity were similar between the control and surfactant-treated groups.
- Infant birth weight was the only significant factor related to the incidence and severity of retinopathy of prematurity.
Conclusions:
- Prophylactic surfactant therapy is unlikely to change the incidence of retinopathy of prematurity in extremely low-birth-weight infants.
- Decreased mortality in extremely low-birth-weight infants may lead to an increased absolute number of ROP cases, as these infants are most susceptible.
Objective:
The use of exogenous surfactant has led to a decrease in mortality of low-birth-weight infants. In some instances, use of this drug has also led to a reduction in neonatal morbidity, such as respiratory distress syndrome. This study was undertaken to determine whether prophylactic surfactant therapy has an effect on the incidence and severity of retinopathy of prematurity.
Design:
The authors reviewed the findings of sequential prospective ophthalmologic examinations performed in two neonatal intensive care units that participated in randomized trials of prophylactic exogenous mammalian surfactant.
Patients:
There were 43 patients in the control group (no prophylactic surfactant) and 43 patients in the prophylactic surfactant group. These groups did not differ on the basis of birth weight, gestational age, race, or gender.
Results:
The incidence and severity of retinopathy of prematurity did not vary between the control and surfactant-treated infants. Only birth weight appeared to be significantly related to the incidence and severity of retinopathy of prematurity.
Conclusions:
These results suggest that the widespread use of prophylactic surfactant therapy will not change the incidence of retinopathy of prematurity in extremely low-birth-weight infants. However, the absolute number of affected patients will likely increase because of the decrease in mortality of extremely low-birth-weight patients, the patients most at risk for retinopathy of prematurity.