Comparison of Outcomes between Prophylactic and Rescue Therapy of Surfactant in Premature Infants

Abstract

Purpose:To compare early and later surfactant instillation in neonates with a birth weight of <1,250 g and/or less than 30 weeks' gestation, following the changes in the National Health Insurance policy of the Republic of Korea. Methods: Preterm infants diagnosed with respiratory distress syndrome and instilled with an exogenous surfactant from April 2006 to August 2012 were included in this study. The subjects were divided into the two groups: the prophylactic group (n=19) included neonates who were instilled with surfactant within 30 minutes after birth in the delivery or operating room, and the rescue group (n=27) included neonates who were treated with surfactant from 30 minutes to 10 hours after birth for the treat ment of respiratory distress syndrome. We compared the two groups in terms of short and long term outcomes. Results: The groups showed no significant difference in gestational age and birth weight. The prophylactic group had a shorter duration of mechanical ven tilation of synchronized intermittent mandatory ventilation but longer parenteral nutrition and mechanical ventilation, including continuous positive airway pressure without synchronized intermittent mandatory ventilation. There are significant differences in the occurrence of long term common com plications such as patent ductus arteriosus and parenteral nutrition asso ciated cholestasis. The ventilation index, oxygenation index, mean airway pressure, and arterial to alveolar oxygen pressure ratio were lower in the prophylactic group than in the rescue group. Conclusion: In comparison with late instillation, early surfactant instillation can reduce the period and requirement of mechanical ventilation. It also reduces the occurrence of patent ductus arteriosus and parenteral nutrition associated cholestasis in newborns.