Surfactant replacement therapy in neonates with respiratory distress syndrome: A collective evaluation of trials from 16 hospitals

Bae, Chong Woo; Kwon, Young Dae; Ko, Se Joong; Kim, Kee Soo; Kim, Hang Mi; Park, Won Soon; Byun, Sang Hyun; Son, Chang Sung; Ahn, Ho Sik; Lee, Sang Geel; Chang, Young Pyo; Chung, Yoon Joo

Abstract

Surfactant replacement therapy in neonates with respiratory distress syndrome (RDS) has been introduced in our country since May 1990. The purpose of this study was to assess the effect and short-term outcome of surfactant replacement for neonatal RDS using collective data of uncontrolled trials from different hospitals in Korea. For the period May 1990 to Dec. 1991, a total of 68 RDS neonates were treated with a reconstituted bovine surfactant (Surfactant-TA) at 17 hospitals. Data on 60 neonates were collected from 16 hospitals and were analyzed in this study. In order to examine the factors that might influence the mortality, we performed a stepwise discriminant analysis. RDS was diagnosed according to accepted clinical and radiographic criteria at each hospital. The mean gestational age of 60 neonates was 31+/-3 weeks (1 SD, range, 24~40 wk) and the mean birth weight was 1549+/-566 grams (range, 590~3300 gm). Surfactant treatment resulted in a significant improvement in ventilatory requirement during the subsequent clinical course. However, there were large variations in the instillation procedure (single vs repeated instillations), dose of surfactant, and respirator settings after surfactant treatment. The neonatal mortality was 40% in this group. When the effect of surfactant treatment was compared between survival and death group, the magnitude of improvement was significantly less in death group than that in survival group. Factors affecting the neonatal mortality include a poor response to surfactant, sepsis and/or DIC, decreasing gestational age and weight, acidosis before treatment and air-leaks. We conclude that treatment with Surfactant-TA has an impact on the clinical course of RDS. To optimize the effects of surfactant therapy, the following refinement will be needed: better initial stabilization with respect to blood pressure, blood gases and pH, instillation techniquse including pre-and post-surfactant ventilation, weaning guidelines, dose, dose schedule, as well as timing of treatment, management of infection, and prevention of severe birth asphyxia.