A Comparison of Surfactant as Immediate Prophylaxis and as Rescue Therapy in Newborns of Less Than 30 Weeks' Gestation

• Published in: The New England journal of medicine Vol. 324; no. 13; pp. 865 - 871
• Main Authors: Kendig, James W, Notter, Robert H, Cox, Christopher, Reubens, Linda J, Davis, Jonathan M, Maniscalco, William M, Sinkin, Robert A, Bartoletti, Albert, Dweck, Harry S, Horgan, Michael J, Risemberg, Herman, Phelps, Dale L, Shapiro, Donald L
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 28-03-1991
• Subjects: Babies; Biological and medical sciences; Clinical Protocols; Clinical trials; Colleges & universities; Drug dosages; Emergencies; Gestational age; Humans; Infant, Newborn; Infants; Lungs; Medical sciences; Neonates; Newborn babies; Outcome and Process Assessment (Health Care); Oxygen Inhalation Therapy; Patients; Pediatrics; Pharmacology. Drug treatments; Pneumothorax; Pneumothorax - etiology; Pneumothorax - therapy; Prophylaxis; Proportional Hazards Models; Pulmonary Surfactants - administration & dosage; Pulmonary Surfactants - therapeutic use; Respiration; Respiratory distress syndrome; Respiratory Distress Syndrome, Newborn - mortality; Respiratory Distress Syndrome, Newborn - prevention & control; Respiratory Distress Syndrome, Newborn - therapy; Respiratory system; Respiratory therapy; Respiratory tract; Resuscitation; Surfactants; Survival; Trachea; Ventilators; New York; United States > US; Human; Premature; Multicenter study; Idiopathic; Respiratory intensive care; Respiratory system; Prevention; Chemotherapy; Randomization; Treatment; Pulmonary surfactant; Respiratory distress; Intratracheal administration
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM199103283241301

EXOGENOUS pulmonary surfactants have been administered into the trachea both to prevent and to treat the respiratory distress syndrome in premature infants. Randomized clinical trials of surfactant-replacement therapy
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have demonstrated a reduction in the incidence and severity of respiratory distress syndrome in infants born at less than 30 weeks' gestation. Two different strategies for the initiation of surfactant therapy have been used in these trials: a prophylactic approach
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and a rescue approach.
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When surfactant is used as prophylaxis,
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it is administered in the delivery room either as soon as it is possible to intubate (immediate administration) or after a stabilization . . .