Document Detail


An observational study of surfactant treatment in infants of 23-30 weeks' gestation: comparison of prophylaxis and early rescue.
MedLine Citation:
PMID:  14694975     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To test the clinical efficacy of exogenous surfactant for treatment of neonatal respiratory distress syndrome (RDS).
METHODS: In a retrospective multicenter observational study, data were collected on 987 infants of 23-30 weeks' gestation given surfactant for respiratory problems within 3 h of birth. Obstetric, neonatal and short-term outcome data were retrieved from recording charts and analyzed after subdivision of the sample into two treatment groups: prophylaxis (surfactant within 15 min) and early rescue (surfactant at 16-180 min).
RESULTS: A total of 965 infants were eligible for the study: 244 receiving prophylaxis and 721 receiving early rescue. The prophylaxis group had lower gestational ages and birth weights than the early rescue group (p = 0.0001), but were otherwise comparable. Natural surfactants were used in > 90% of infants in both groups. The rates of retreatments and the mean total doses of surfactant were similar in both groups. Babies receiving prophylaxis presented less grade 3-4 RDS than those receiving early rescue (32.4% vs. 53.8%, p = 0.0001). Those requiring prophylaxis also needed lower peak inspiratory pressure and had a shorter duration of oxygen therapy. Mortality and complications were similar between the groups, but babies receiving prophylaxis had less pulmonary interstitial emphysema (p = 0.0006) and periventricular leukomalacia (p = 0.0113) than infants receiving early rescue.
CONCLUSIONS: In clinical practice, prophylaxis was preferred in babies with lower birth weights and gestational ages compared to early rescue treatment. Not surprisingly, infants treated with prophylactic surfactant had a lower rate of RDS than the infants treated by early rescue, even though they did not need less surfactant overall.
Authors:
G Bevilacqua; S Parmigiani;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study    
Journal Detail:
Title:  The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians     Volume:  14     ISSN:  1476-7058     ISO Abbreviation:  J. Matern. Fetal. Neonatal. Med.     Publication Date:  2003 Sep 
Date Detail:
Created Date:  2003-12-25     Completed Date:  2004-03-04     Revised Date:  2013-06-03    
Medline Journal Info:
Nlm Unique ID:  101136916     Medline TA:  J Matern Fetal Neonatal Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  197-204     Citation Subset:  IM    
Affiliation:
Department of Gynecological, Obstetrical and Neonatological Sciences, Section of Child Health and Neonatology, University of Parma, Italy.
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MeSH Terms
Descriptor/Qualifier:
Biological Agents / therapeutic use*
Drug Administration Schedule
Drug Combinations
Fatty Alcohols / therapeutic use*
Gestational Age
Humans
Infant, Low Birth Weight / physiology
Infant, Newborn
Infant, Premature
Italy / epidemiology
Lipids / therapeutic use*
Oxygen Inhalation Therapy / utilization
Phospholipids / therapeutic use*
Phosphorylcholine / therapeutic use*
Polyethylene Glycols / therapeutic use*
Respiration, Artificial / utilization
Respiratory Distress Syndrome, Newborn / drug therapy*,  mortality,  physiopathology,  prevention & control*
Retrospective Studies
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Biological Agents; 0/Drug Combinations; 0/Fatty Alcohols; 0/Lipids; 0/Phospholipids; 0/Polyethylene Glycols; 0/SF-RI 1, bovine surfactant preparation; 107-73-3/Phosphorylcholine; 99732-49-7/dipalmitoylphosphatidylcholine, hexadecanol, tyloxapol drug combination; KE3U2023NP/poractant alfa
Comments/Corrections
Comment In:
J Matern Fetal Neonatal Med. 2003 Sep;14(3):145-6   [PMID:  14694967 ]

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