The Turkish Journal of Pediatrics
2012 , Vol 54 , Num 4
Is there a necessity for multiple doses of surfactant for respiratory distress syndrome of premature infants?
2nd NICU and Neonatology Department, Aristotle University of Thessaloniki, G.P.N. Papageorgiou, Thessaloniki, Greece.
E-mail: dokos1984@yahoo.gr
Both prophylactic and early surfactant (SF) replacement therapy reduce
pulmonary complications and mortality in ventilated infants with respiratory
distress syndrome (RDS). The effectiveness of one or more doses and the
impact on morbidity and mortality of premature neonates with RDS need
to be further clarified. The objective of this study was to investigate the
necessity of repeated surfactant replacement therapy in premature infants
≤32 weeks of gestational age and the possibility of an underlying pathology.
This study included 126 premature neonates of 24–32 weeks of gestation.
We used 200 mg/kg per dose of porcine surfactant (Curosurf®) as primary
treatment and 100 mg/kg in cases that required retreatment. The subjects
were classified into two groups: the first group (Group 1) received a single
dose of surfactant (n=98) and the second group (Group 2) included infants
who required more than one dose (n=28). The 1st dose was administered
in the first 20 minutes after birth while the second was given six hours
later. In four cases, a 3rd dose was required, that was provided 12 hours
after birth. Recorded data included: clinical and radiological classification of
RDS, extubation time, oxygenation estimation indexes (OI: oxygenation index,
A-aDO2: alveolar-arterial oxygen difference, a/APO2: arterial-alveolar ratio of
partial oxygen pressure), requirement and duration of oxygen administration,
total duration of mechanical ventilation, and survival rate. Patient Group 1 did
not present any radiological findings of RDS of grade 3 or 4 six hours after
SF administration, whereas such findings were recorded in three neonates
of Group 2. Therefore, we assumed that failure of a single-dosing treatment
indicates a more severe RDS and might reflect an underlying pathology.
The impact of maternal chorioamnionitis in the neonates that necessitated
further replacement therapy was statistically significant (p=0.045); moreover,
infection markers were positive in the majority of the patient population
of the second group. Twenty-two neonates (22%) of the first group needed
intubation in the delivery room compared to 16 (57%) of the second group
(p=0.0001). In conclusion, premature infants treated with a single dose of
surfactant can usually be successfully extubated. Requirement of retreatment
could be attributed to other pathogenetic mechanisms. A positive history of
maternal chorioamnionitis was the commonest reason.
Keywords :
pulmonary surfactant, respiratory distress syndrome, newborn, prematurity.