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Effect of neonatal surfactant therapy on lung function at school age in children born very preterm
A S Pelkonen1, A L Hakulinen, M Turpeinen
1Department of Allergic Diseases, Helsinki University Central Hospital, Finland.
Insights
Exogenous surfactant therapy improves long-term lung function in very preterm infants. Surfactant treatment reduced bronchial obstruction and improved spirometric parameters in children born before 30 weeks gestation.
Area of Science:
- Pediatrics
- Neonatology
- Pulmonology
Background:
- Very preterm birth (before 30 weeks gestation) is associated with immature surfactant systems.
- Neonatal respiratory distress syndrome (RDS) is a common complication in these infants.
- Long-term pulmonary sequelae in survivors of very preterm birth are not fully understood.
Purpose of the Study:
- To evaluate the long-term pulmonary functional outcomes of exogenous surfactant therapy in children born very preterm.
- To compare spirometric parameters between surfactant-treated and placebo groups.
- To identify factors associated with favorable pulmonary outcomes.
Main Methods:
- A randomized controlled trial involving 40 children born before 30 weeks gestation, treated with prophylactic or rescue human surfactant, or placebo.
- Comparison of spirometric parameters (including forced vital capacity and peak expiratory flow) with 20 term-born controls.
- Home spirometry monitoring for 4 weeks and assessment of bronchial obstruction and beta2-agonist responsiveness.
Main Results:
- Preterm children exhibited significantly lower spirometric parameters than controls, except for FVC in the prophylactic group.
- Bronchial obstruction was prevalent (36-67%) in preterm groups, with 0% in controls.
- Surfactant therapy and shorter intubation time were independently associated with improved spirometric outcomes.
Conclusions:
- Exogenous surfactant therapy positively impacts long-term pulmonary function in very preterm infants.
- Surfactant supplementation may mitigate the severity of bronchial obstruction related to immaturity.
- Early surfactant administration appears beneficial for reducing long-term respiratory morbidity.
Abstract:
Our aim was to evaluate long-term effects of exogenous surfactant therapy on pulmonary functional outcome in children born very preterm. We examined 40 children aged 7-12 years who were born before 30 weeks of gestation with an immature surfactant system, and were randomized to one of three treatment groups: human surfactant given at birth (prophylactic), human surfactant given after development of neonatal respiratory distress syndrome (rescue), and placebo (air) treatment. Spirometric parameters of preterm born children were compared with those of 20 children born at term. In addition, spirometric parameters were monitored twice daily for 4 weeks using a home spirometer. All spirometric parameters were significantly lower in the preterm groups than in the controls, except for the forced vital capacity (FVC) in the prophylactically treated group. Bronchial obstruction was found in 53% of the prophylactically treated group, in 36% of the rescue group, in 67% of the placebo group, and in 0% of the control group. Peak expiratory flow (PEF) and FVC values were higher in those children who received surfactant compared with the placebo group (P < 0.05). In 16 children (40%) born preterm, a beta2-agonist induced an increase in PEF > or = 15% at least three times during 2 weeks of home monitoring; eight children (20%) had abnormal diurnal PEF variation. Multiple regression analysis indicated that the independent variables associated with favorable outcomes in spirometric parameters were surfactant therapy (P = 0.012-0.045) and short intubation time after birth (P = 0.0009-0.0044). Bronchial obstruction, responsiveness to a beta2-agonist, and high diurnal PEF variation are common in children born before 30 gestational weeks. Surfactant supplementation reducing the need for mechanical ventilation or supplementary oxygen after birth may decrease the severity of immaturity related bronchial obstruction in childhood.