Early regular versus late selective poractant treatment in preterm infants born between 25 and 30 gestational weeks: a prospective randomized multicenter study

Abstract Objective: Surfactant treatment in the early hours of life significantly decreases the rates of death and air leak, and increases survival without bronchopulmonary dysplasia (BPD) in preterm infants. We aimed to compare the impact of early surfactant (ES) administration to late selective (L...

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Published in:	The journal of maternal-fetal & neonatal medicine Vol. 27; no. 4; pp. 411 - 415
Main Authors:	Dilmen, U ur, Özdemir, Ramazan, Tatar Aksoy, Hatice, Uras, Nurdan, Demirel, Nihal, K rimi, Ercan, Erdeve, Ömer, Özer, Esra, Ba, Ahmet Ya mur, Gürsoy, Tu ba, Zenciro lu, Ay egül, Oval, Fahri, O uz, . Suna
Format:	Journal Article
Language:	English
Published:	England Informa UK Ltd 01-03-2014 Taylor & Francis
Subjects:	Biological Products - administration & dosage Biological Products - therapeutic use Bronchopulmonary dysplasia Bronchopulmonary Dysplasia - mortality Bronchopulmonary Dysplasia - prevention & control Bronchopulmonary Dysplasia - therapy Combined Modality Therapy Drug Administration Schedule Female Gestational Age Humans Infant, Newborn Infant, Premature Intracranial Hemorrhages - prevention & control Male Phospholipids - administration & dosage Phospholipids - therapeutic use pneumothorax Pneumothorax - prevention & control poractant preterm Prospective Studies Pulmonary Surfactants - administration & dosage Pulmonary Surfactants - therapeutic use Respiration, Artificial Retinopathy of Prematurity - prevention & control surfactant Treatment Outcome
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Summary:	Abstract Objective: Surfactant treatment in the early hours of life significantly decreases the rates of death and air leak, and increases survival without bronchopulmonary dysplasia (BPD) in preterm infants. We aimed to compare the impact of early surfactant (ES) administration to late selective (LS) treatment on neonatal outcomes in preterm infants. Methods: All preterm infants between 25 and 30 wks gestational age and who were not entubated in the delivery room and did not have any major congenital malformation or perinatal asphyxia were randomized to ES treatment (200 mg/kg Curosurf® administration in 1 hour after birth) or LS treatment (200 mg/kg Curosurf®administration in the first 6 h of life if needed). The patients were treated by nasal continuous positive airway pressure (nCPAP) treatment regardless of the surfactant requirement. Outcomes were the necessity of mechanical ventilation, nCPAP duration, the oxygen requirement duration, the rates of BPD, retinopathy of prematurity (ROP) and mortality, and the assesment of the following situations; (pneumothorax, patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH) grade III). Results: Among 159 infants enrolled in the study, 79 were randomized to ES and 80 to LS treatment groups. Thirty-five patients (44%) in the LS treatment group needed surfactant administration. Necessity of second dose surfactant administration was 8.9% in the ES treatment group. Although necessity of mechanical ventilation, nCPAP duration, oxygen need duration, rates of PDA, NEC, BPD, ROP stage >3 and mortality did not show a significant difference between groups, the ES treatment group had lower rates of pneumothorax and IVH grade III when compared to the LS treatment group. Conclusions: ES treatment decreases IVH ( grade III) and pneumothorax rates but does not have any effect on BPD when compared to LS.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-News-2 ObjectType-Feature-3 content type line 23
ISSN:	1476-7058 1476-4954
DOI:	10.3109/14767058.2013.818120