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

Abstract

We found a significant advantage to the administration of the initial dose of surfactant as prophylaxis rather than as rescue therapy in very premature infants.

Comparison of Infasurf (Calf Lung Surfactant Extract) to Survanta (Beractant) in the Treatment and Prevention of Respiratory Distress Syndrome

“…Early administration of any surfactant to preterm infants at high risk of RDS is more effective than waiting until development of severe respiratory symptoms, as evidenced by lower severity of acute disease and lower incidence of death and chronic lung disease. 25,26 Although this study did not compare prophylaxis to treatment, we note that the duration of effect, for both surfactants, was substantially longer in the prevention arm as compared with the treatment arm.…”

Surfactant Therapy Failure Identifies Infants at Risk for Pulmonary Mortality

“…These infants were also at greater risk for having a PDA develop, but because echocardiography was not routinely performed, the contribution of a PDA to pulmonary hemorrhage is difficult to assess. The infants who died may have derived additional benefit from sur¬ factant therapy within the first few minutes of life, as sug¬ gested by Kendig et al 1 However, the pulmonary mecha¬ nisms that accounted for lack of response were not simply BW or GA dependent because 35% of the deaths occurred in infants who weighed more than 1000 g at birth.…”

The Surfactants

“…The theoretical advantages to such a strategy include replacing surfactant before the onset of respiratory insufficiency and thus decreasing barotrauma. Benefits of using this strategy were seen in some trials, [30][31][32][33] but not others. 34,35 Overall, the randomized trials show a decrease in the risk of air leaks and lower incidence of BPD or death in the group treated with prophylactic surfactant in the delivery room compared with later treatment.…”