J Korean Med Sci.  2017 Aug;32(8):1288-1294. 10.3346/jkms.2017.32.8.1288.

Prophylactic versus Early Rescue Surfactant Treatment in Preterm Infants Born at Less than 30 Weeks Gestation or with Birth Weight Less than or Equal 1,250 Grams

• Chun J
• Sung SI
• Ho YH
• Kim J
• Park GY
• Yoon SA
• Ahn SY
• Chang YS
• Park WS

• KMID: 2439463
• DOI: http://doi.org/10.3346/jkms.2017.32.8.1288

Abstract

Prophylactic surfactant is known to be effective to reduce chronic lung disease in preterm infants compared with rescue surfactant treatment. In Korea, early prophylactic surfactant therapy was introduced in 2011. However, recently, the increased utilization of antenatal steroids and early stabilization through continuous positive airway pressure (CPAP) in the delivery room may have changed the risks and benefits of prophylactic surfactant therapy of infants at high risk of respiratory distress syndrome (RDS). We compared the effects and safety of prophylactic surfactant therapy (within 30 minutes after birth) and early selective surfactant therapy (within 3 hours after birth) in preterm infants born at < 30 weeks gestation or with birth weight ≤ 1,250 g. The clinical data of 193 infants in period 1 (from 2008 to 2010, early selective surfactant therapy group) were collected retrospectively; those of 191 infants in period 2 (from 2012 to 2014, prophylactic surfactant therapy group) were collected prospectively. Compared to period 1, the rate of intubation and surfactant use were significantly increased in period 2. The use of multiple doses of surfactant in period 2 was significantly increased compared with period 1. Despite more invasive and aggressive management in period 2, there was no difference in the duration of mechanical ventilation, the incidence of bronchopulmonary dysplasia (BPD) or death, and the risk of other adverse neonatal outcomes between the 2 groups. In conclusion, the benefit of prophylactic surfactant therapy in infants treated under current practices is no longer clear compared to early selective surfactant therapy.

Keyword

Surfactant; Respiratory Distress Syndrome; Premature Infant

MeSH Terms

Birth Weight*
Bronchopulmonary Dysplasia
Continuous Positive Airway Pressure
Delivery Rooms
Humans
Incidence
Infant
Infant, Newborn
Infant, Premature*
Intubation
Korea
Lung Diseases
Parturition*
Pregnancy*
Prospective Studies
Respiration, Artificial
Retrospective Studies
Risk Assessment
Steroids
Steroids

Figure

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  Fig. 1 Flowchart of the study population.

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  Fig. 2 Distribution of the study population with regard to intubation and surfactant use in accordance with gestational age. GA = gestational age. *P < 0.05.

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