Does timing of initial surfactant treatment make a difference in rates of chronic lung disease or mortality in premature infants? An observational regional study

Abstract

Objective: To compare two treatment strategies in preterm infants with or at risk of respiratory distress syndrome: early surfactant administration (within one hour of birth) versus late surfactant administration, in a geographically defined population.

Outcome: The primary outcome was chronic lung disease (CLD) and mortality before/at 36 weeks. Secondary outcomes included: duration of mechanical ventilation and continuous positive airway pressure (CPAP), post-natal steroids for CLD and major neonatal morbidities.

Subjects: Premature infants born at 22–32 weeks’ gestation between January 2006 and December 2009.

Setting: Ten neonatal intensive care units (NICUs) in New South Wales (NSW) and Australian Capital Territory (ACT), Australia.

Design: Retrospective analysis of prospectively collected data from the regional NICU database in NSW and ACT.

Results: Of the 2170 infants who received surfactant, 1182 (54.5%) and 988 (45.5%) received early and late surfactant, respectively. The early surfactant group was less mature (27.1 ± 2.1 versus 29.4 ± 2.1 weeks) and had more CLD and mortality (40.2% versus 20.0%). The multivariable analysis showed early surfactant to be associated with less duration of ventilation, longer duration of CPAP and longer hospital stay but had little or no impact on CLD/mortality.

Conclusion: Early surfactant administration is associated with shorter duration of ventilation but does not appear to be significantly protective against CLD/mortality among premature infants. This may support the growing evidence for consideration of CPAP as an alternative to routine intubation and early surfactant administration. Further investigation from large randomized clinical trials is warranted to confirm these results.

• Chronic lung disease
• low birth weight
• mortality
• premature
• preterm
• surfactant
• survival

Acknowledgements

The authors thank the Directors, the NICUS members and the audit officers of all tertiary units in supporting this collaborative study: NICUS, Dr Jennifer Bowen (Chairperson), Barbara Bajuk (Coordinator); Canberra Hospital, A/Prof. Zsuzsoka Kecskés (Director), A/Prof. Alison Kent, John Edwards; John Hunter Children’s Hospital, Dr Chris Wake (Director), Lynne Cruden; Royal Prince Alfred Hospital, A/Prof. Nick Evans (Director), Dr Phil Beeby, A/Prof. David Osborn, Shelley Reid; Liverpool Hospital, Dr Robert Guaran (Director), Dr Ian Callander, Kathryn Medlin, Sara Wilson; Nepean Hospital, Dr Lyn Downe (Director), Mee Fong Chin; The Children’s Hospital at Westmead, Prof. Nadia Badawi (Director), Robert Halliday, Caroline Karskens; Royal North Shore Hospital, Dr Jennifer Bowen (Director), Dr Mary Paradisis, A/Prof. Martin Kluckow, Sara Sedgley; Sydney Children’s Hospital, Dr Andrew Numa (Director), Dr Gary Williams, Janelle Young; Westmead Hospital, Dr Mark Tracy (Director), Jane Baird; and Royal Hospital for Women, A/Prof. Kei Lui (Director), Dr Julee Oei, Diane Cameron. We also thank the babies and their families, the nursing and midwifery, obstetric and medical records staff of the obstetric and children’s hospitals in NSW and the ACT.

Declaration of interest

The authors have no conflicts of interest to declare.

D. Premnath was funded by The Canberra Hospital Private Practice Fund Sponsored Vacation Scholarship specifically to undertake this study.