Prophylactic versus Early Rescue Surfactant Treatment in Preterm Infants Born at Less than 30 Weeks Gestation or with Birth Weight Less than or Equal 1,250 Grams

Abstract

Prophylactic surfactant is known to be effective to reduce chronic lung disease in preterm infants compared with rescue surfactant treatment. In Korea, early prophylactic surfactant therapy was introduced in 2011. However, recently, the increased utilization of antenatal steroids and early stabilization through continuous positive airway pressure (CPAP) in the delivery room may have changed the risks and benefits of prophylactic surfactant therapy of infants at high risk of respiratory distress syndrome (RDS). We compared the effects and safety of prophylactic surfactant therapy (within 30 minutes after birth) and early selective surfactant therapy (within 3 hours after birth) in preterm infants born at < 30 weeks gestation or with birth weight ≤ 1,250 g. The clinical data of 193 infants in period 1 (from 2008 to 2010, early selective surfactant therapy group) were collected retrospectively; those of 191 infants in period 2 (from 2012 to 2014, prophylactic surfactant therapy group) were collected prospectively. Compared to period 1, the rate of intubation and surfactant use were significantly increased in period 2. The use of multiple doses of surfactant in period 2 was significantly increased compared with period 1. Despite more invasive and aggressive management in period 2, there was no difference in the duration of mechanical ventilation, the incidence of bronchopulmonary dysplasia (BPD) or death, and the risk of other adverse neonatal outcomes between the 2 groups. In conclusion, the benefit of prophylactic surfactant therapy in infants treated under current practices is no longer clear compared to early selective surfactant therapy.

Construction process of an illustrated guide for health education on airway obstruction in children

“…In the third stage, infants < 32 weeks GA were selected and classified as very preterm (≥ 28 to < 32 weeks) or extremely preterm (≥ 22 to < 28 weeks) (Castro et al, 2016;Chawanpaiboon et al, 2019). Infants were further stratified on the basis of weight/gestational age ratio as appropriate for gestational age (AGA), small for gestational age (SGA), or large for gestational age (LGA) (Chun et al, 2017).…”

Table, an imagetic representation in the construction of scientific knowledge

“…In the third stage, infants < 32 weeks GA were selected and classified as very preterm (≥ 28 to < 32 weeks) or extremely preterm (≥ 22 to < 28 weeks) (Castro et al, 2016;Chawanpaiboon et al, 2019). Infants were further stratified on the basis of weight/gestational age ratio as appropriate for gestational age (AGA), small for gestational age (SGA), or large for gestational age (LGA) (Chun et al, 2017). To analyze factors associated with the unfavorable outcome of preterm infants in this cohort, variables were evaluated according to the characteristics of each group and the chronology of related events, namely: maternal/gestational factors, childbirth-related factors, and neonatal factors.…”

Using a Bundle Approach to Prevent Bronchopulmonary Dysplasia in Very Premature Infants

“…Recent studies regarding surfactant administration have focused on the optimal timing of administration and less invasive methods of administration. Prophylactic or early surfactant has been compared to rescue or late surfactant in several studies, and while both methods have been found to be feasible, there was no significant difference found in BPD or mortality rates between the groups 25,26. Less invasive methods of surfactant administration that do not require endotracheal intubation or mechanical ventilation are becoming more common 27.…”

“…Prophylactic or early surfactant has been compared to rescue or late surfactant in several studies, and while both methods have been found to be feasible, there was no significant difference found in BPD or mortality rates between the groups. 25,26 Less invasive methods of surfactant administration that do not require endotracheal intubation or mechanical ventilation are becoming more common. 27 Some of the studied methods include using a laryngeal mask airway, an oral suction catheter and direct laryngoscopy, or a nebulizer.…”