Use and timing of surfactant administration: impact on neonatal outcomes in extremely low gestational age infants born in Canadian Neonatal Intensive Care Units

Abstract

Background: Use, timing and doses of surfactant in preterm infants are variable in practice in modern NICUs.

Objective: The objective of this study is to explore the association between use and timing of surfactant administration and common neonatal adverse outcomes in preterm infants with gestational age (GA) < 28 weeks.

Material and methods: Neonates admitted to a participating Canadian Neonatal Network NICU between 2013 and 2015 were studied. Infants were divided into three groups based on surfactant administration: none, early (within 30 min of life), and late surfactant (>30 min). The primary outcome was a composite of ≥2 predefined outcomes: bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP) and severe neurological injury (intraventricular hemorrhage or intraventricular hemorrhage (IVH) grade III/IV ± periventricular leukomalacia).

Results: Of 2512 eligible neonates, 430 were in the early, and 1228 were in the late surfactant group. There was no difference in the primary outcome (p = .88). There was a slightly lower risk of late onset sepsis [25% versus 29%, adjusted odds ratio (aOR): 0.8; 95% CI: 0.6–0.9] and ROP (12.4 versus 15%, aOR: 0.7; 95% CI: 0.5–0.9) in the early surfactant group.

Conclusions: In preterm neonates, early administration of surfactant within 30 min of life was not associated with an increased risk of the primary composite outcome, but did have decreased rates of late onset sepsis and ROP.

Keywords:

• Bronchopulmonary dysplasia
• neonatal intensive care unit
• premature Infant
• retinopathy of prematurity
• surfactant

Acknowledgements

The authors would like to acknowledge the staff of the Canadian Neonatal Network and Canadian neonatal Follow-up Network Coordinating Center for their tireless and diligent work and Natasha Musrap, PhD, (Maternal Infant Care Research Centre, Mount Sinai Hospital) for editorial assistance. The Maternal–Infant Care Research Centre is supported by the Ontario Ministry of Health and Long-Term Care. Organizational support to the Canadian Neonatal Network is provided by the Canadian Institutes of Health Research-funded Team in Maternal–Infant Care. The authors thank the data abstractors of the CNN, staff of the CNN, and CNFUN coordinating centers for providing organizational support, and all CNN and CNFUN site investigators: A. Synnes (Director, CNFUN), Children’s & Women’s Health Centre of British Columbia, Vancouver, British Columbia; P. S. Shah (Director, CNN), Mount Sinai Hospital, Toronto, Ontario; A. Harrison and T. Pillay, Victoria General Hospital, Victoria, British Columbia; Z. Cieslak, Royal Columbian Hospital, New Westminster, British Columbia; T. Sorokan and R. Sherlock, Surrey Memorial Hospital, Surrey, British Columbia; J. Ting, Children’s & Women’s Health Centre of British Columbia, Vancouver, British Columbia; W. Yee and R. Sauve, Foothills Medical Centre, Calgary, Alberta; K. Aziz, Royal Alexandra Hospital, A. Reichert, Glenrose Rehabilitation Hospital, Edmonton, Alberta; Z. Kalapesi and J. Bodani, Regina General Hospital, Regina, Saskatchewan; K. Sankaran and S. Daspal, Royal University Hospital, Saskatoon, Saskatchewan; M. Seshia and D. Moddemann, Winnipeg Health Sciences Centre, Winnipeg, Manitoba; R. Alvaro, St. Boniface General Hospital, Winnipeg, Manitoba; S. Shivananda and S. el Helou, Hamilton Health Sciences Centre, Hamilton, Ontario; O. DaSilva and D. Lee, London Health Sciences Centre, London, Ontario; C. Nwaesei, Windsor Regional Hospital, Windsor, Ontario; K. S. Lee and L. Ly, Hospital for Sick Children, Toronto, Ontario; E. Kelly, Mount Sinai Hospital, Toronto, Ontario; M. Dunn and P. Church, Sunnybrook Health Sciences Centre, Toronto, Ontario; N. Rouvinez-Bouali, Brigitte Lemyre, and T. Daboval, Children’s Hospital of Eastern Ontario and Ottawa General Hospital, Ottawa, Ontario; K. Dow, Kingston General Hospital, Kingston, Ontario; E. Pelausa, Jewish General Hospital, Montreal, Quebec; K. Barrington and F. Lefebvre, Hopital Sainte-Justine, Montreal, Quebec; C. Drolet and S. Belanger, Centre Hospitalier Universitaire de Quebec, Sainte Foy; P. Riley and M. Claveau, Montreal Children’s Hospital, Montreal, Quebec; D. Faucher, Royal Victoria Hospital, Montreal, Quebec; V. Bertelle, E. Masse, and C. Demers, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec; R. Canning, Moncton Hospital, Moncton, New Brunswick; B. Bulleid and H. Makary, Dr Everett Chalmers Hospital, Fredericton, New Brunswick; C. Ojah and L. Monterrosa, Saint John Regional Hospital, Saint John; A. Deshpandey and P. Murphy, Janeway Children’s Health and Rehabilitation Centre, St. John’s, Newfoundland; J. Afifi and M. Vincer, IWK Health Centre, Halifax, Nova Scotia; A. Kajetanowicz, Cape Breton Regional Hospital, Sydney, Nova Scotia; and Shoo K. Lee (Chairman, CNN), Mount Sinai Hospital, Toronto, Ontario.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

None.