Improved survival and neurodevelopmental outcome after prolonged ventilation in preterm neonates who have received antenatal steroids and surfactant

Abstract

Aims-To assess survival and neurodevelopmental outcome following prolonged ventilation beyond 27 or 49 days of postnatal life in neonates treated with antenatal steroids and surfactant. Methods-The medical records of 84 babies born in 1994-1996 requiring ventilation after 27 postnatal days at Liverpool Women's Hospital were reviewed to determine the duration of mechanical ventilation, survival, and neurodevelopmental outcome at 3 years of age. Results-Fifty six babies were mechanically ventilated after 27 postnatal days but for less than 50 days; 48 (86%) survived to 3 years. Twenty six (54%) of the survivors had normal neurodevelopment at 3 years and seven (15%) had only mild disability. Twenty eight babies were ventilated after 49 postnatal days; 14 survived to 3 years. Five of these survivors were neurodevelopmentally normal at 3 years and two had mild disability. Conclusions-Survival decreases with more prolonged ventilation. When antenatal steroids and postnatal surfactant are used, there appears to be improved survival and neurodevelopmental outcome in preterm babies who require prolonged ventilation. (Arch Dis Child Fetal Neonatal Ed 2001;84:F194-F196)

Outcome of very low birthweight infants after introducing a new standard regime with the early use of nasal CPAP

“…Long-term outcome is the gold standard for all neonatal interventions and therapy, and further studies should be performed, as suggested by Clark et al [10] and as carried out by Stjernquist and Svenningsen [40], Gaillard et al [12], Kamper et al [25], Hansen et al [16] and Dahl and Kamper [11], for instance.…”

Surfactant-Replacement Therapy for Respiratory Distress in the Preterm and Term Neonate

“…8,11,15,22,27,96 The incidence of other coexistent morbidities in preterm infants, such as bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, nosocomial infections, retinopathy of prematurity, and patent ductus arteriosus, has not changed with surfactant replacement. [2][3][4][5]7,8,22,24 The onset of clinical signs of patent ductus arteriosus may occur earlier, [145][146][147][148] and the incidence of pulmonary hemorrhage, especially in infants of less than 27 weeks' gestation, may be increased.…”

“…8,9 Despite surfactant treatment, the risk of respiratory abnormalities later in infancy (recurrent wheezing, asthma, respiratory infection, pulmonaryfunction test abnormalities) and early childhood remains high for preterm infants with respiratory distress syndrome who require mechanical ventilation. [88][89][90][91][92][93][94][95][96][97][98][99] In a small number of patients followed through school age, pulmonary-function studies seem improved by surfactant replacement. 90 Additional long-term respiratoryfunction studies are needed of children who have received surfactant as neonates.…”

Effects of Two Different Exogenous Surfactant Preparations on Serial Peripheral Perfusion Index and Tissue Carbon Monoxide Measurements in Preterm Infants with Severe Respiratory Distress Syndrome

“…18,19 Treatment with a double dose of poractant alfa (200 mg/kg) is associated with rapid weaning of oxygen and ventilatory pressures, fewer additional doses, cost benefits, and a survival advantage in comparison with beractant or calfactant. 19 In the present study, beractant and double-dose poractant alfa were randomly used, and both surfactant preparations significantly increased the PO 2 levels and decreased FiO 2 requirements and OI.…”