Pulmonary follow‐up 2.5 years after a randomized, controlled, multiple dose bovine surfactant study of preterm newborn infants

Abstract

Forty-seven preterm infants, who were previously enrolled in a prospective, randomized, blinded study at birth to assess the effects of multiple doses of exogenous bovine surfactant to prevent respiratory distress syndrome, underwent lung function evaluation and review of their medical histories at 2 1/2 years of age. During their initial hospitalization there were no differences between the 17 control infants and the 30 surfactant-treated infants in the duration of ventilator or oxygen therapy and the incidence of bronchopulmonary dysplasia. At the follow-up both groups were similar in chronological and corrected ages, weights, lengths, and sex ratios and there were no differences in the occurrence of allergy, asthma, bronchiolitis, eczema, pneumonia, and wheezing. In addition, there was no significant difference regarding the incidence of chest illnesses lasting either 3 or 7 days and in the total number of required rehospitalizations. Functional residual capacity (FRC), tidal volume (VT/kg), compliance (Crs/kg), resistance (Rrs), and time constant of the respiratory system were not significantly different between the two groups at 2 1/2 years of age. We conclude that bovine surfactant, when given during the neonatal period, has little long-term effect on lung function. Neonatal bovine surfactant therapy neither improves nor produces any adverse effects on the developing respiratory system.

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

“…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.…”

Pulmonary function at school-age in surfactant-treated preterm infants

“…This is in keeping with the findings of others. Couser et al 10 did not find abnormal lung function in toddlers following neonatal treatment with natural surfactant, nor did they report any differences between treatment and control groups. However, total respiratory system compliance and resistance as measured in their study were less sensitive markers of small airway disease than R aw as assessed by whole-body plethysmography and forced expiratory flows at 25% vital capacity.…”

“…Respiratory morbidity in childhood depends on the severity of respiratory disease during the neonatal period. 20 In the study of Couser et al, 10 there was a high prevalence of BPD as defined by oxygen dependency on day 28, and this may result in impaired lung function up to at least age 2 years. 21 However, most of the BPD cases in our study population were mild to moderate, which may explain the normal findings in most of our patients.…”

“…Numerous studies showed beneficial effects of exogenous synthetic, natural, or modified natural surfactant on neonatal mortality and pulmonary outcome. [1][2][3][4][5][6][7][8] Although some studies reported lung function of survivors of neonatal RDS following surfactant replacement therapy into infancy and very early childhood, [9][10][11][12] little is known about the longterm effects of neonatal surfactant therapy on pulmonary outcome at early school age.…”

School-age Follow-up of Prophylactic Versus Rescue Surfactant Trial: Pulmonary, Neurodevelopmental, and Educational Outcomes

“…15,[23][24][25][26] Our study is the first to compare the two different modes of surfactant administration with regard to formal pulmonary assessment in long-term follow-up. However, formal pulmonary function evaluations did not distinguish between these two groups in the limited subset of patients in whom testing could be completed.…”