Therapeutic use of surfactant in neonatal respiratory distress syndrome

Abstract

As part of a multicenter surfactant rescue study, the chest X-rays of 239 preterm and term infants were analyzed. To study the influence of surfactant administration on radiographic appearance, 130 patients with a clinical and radiological diagnosis of typical respiratory distress syndrome were selected, in whom adequate chest x-rays before and within 48 h after treatment were available. Median gestational age was 30 weeks (range 25-38 weeks), median birth weight was 1335 g (range 625-3450). The time of surfactant application ranged between 90 min and 24 h after birth (median 6 h). The most common finding after surfactant administration was uniform (n = 47) or disproportionate (n = 46) improvement of pulmonary aeration, which showed a significant correlation to posttreatment reduction of oxygen requirement (p less than 0.0001). Asymmetric clearance was more often localized on the right side and usually disappeared within two to five days. Only in 13 patients no change of ventilation was found. Development of interstitial emphysema (n = 24, including three patients with pneumothorax) after surfactant treatment was an unfavourable prognostic sign. 54% of these patients (13 of 24) died within the first month of life, compared to 8% (7 of 93) in the group of patients with initial improvement of ventilation.

Individualized lung recruitment during high-frequency ventilation in preterm infants is not associated with lung hyperinflation and air leaks

“…Surfactant treatment resulted in a significant improvement in the radiolucency score, a finding consistent with previous studies in conventionally ventilated preterm infants with RDS [ 2 , 7 , 8 , 23 ]. Based on the median radiolucency scores, this improvement is modest, a finding best explained by the fact that the lung was already recruited at the time of surfactant treatment.…”

“…The radiolucency score following lung recruitment is considerably lower than those previously reported in conventionally ventilated preterm infants with RDS [ 2 , 7 , 8 , 23 ]. There may be several reasons explaining this finding.…”

“…Following surfactant treatment, the median FIO 2 was 0.21 (Table 1 ) and there was a clear shift to lower radiolucency scores, with a median [IQR] score of 1 [ 1 , 2 ] (Table 2 ). On an individual level, the radiolucency score improved in 62 % of the 39 paired CXRs ( p < 0.001, Table 3 ).…”

Radiological Assessment of Post Surfactant Changes in Respiratory Distress Syndrome

“…The incidence in our study group was similar (32%). In summary, about 70 % of infants with RDS treated with surfactant (69 % in our study, 69 % in the study of Bick et al 9 clearing had the best long-term outcome: 47 (94 %) of our 50 patients survived, and 32 (68 %) of our surviving infants were breathing spontaneously at day 28 of life without the need for supplementary oxygen. Disproportionate aeration usually resolved within 3-5 days, often after retreatment with surfactant 8 .…”

The lungs in immature infants: How important is surfactant therapy in preventing chronic lung problems?

“…The treatment of HMD or RDS with intratracheal surfactant has revolutionized the outcome in these patients [1][2][3][4]. It has resulted in rapid clearing of the lungs [5,6], and the findings of HMD generally now are seen on a fleeting basis only.…”