Early surfactant therapy and nasal continuous positive airways pressure for mild respiratory distress syndrome – a pilot study

Abstract

Objectives. To determine if the administration of porcine surfactant 100 mg/kg within 24 hours after birth, to infants with
respiratory distress syndrome (RDS) receiving nasal continuous positive airways pressure (NCPAP) and inspired oxygen (FiO2)
0.3 - 0.4, decreased the need for mechanical ventilation (MV) during the first week of life compared with infants in whom the
required FiO2 was allowed to rise above 0.4 before surfactant was administered.
Design and subjects. A study of 102 infants was planned, but terminated early due to slow recruitment, and is presented as
pilot data. Twenty-seven preterm infants were randomised into either a low- or a high-threshold group. The low-threshold
group received surfactant immediately and the high-threshold group received surfactant if their FiO2 rose above 0.4. Infants
who received surfactant were returned to NCPAP if respiratory effort was adequate.
Setting. The Neonatal Intensive Care Unit, Groote Schuur Hospital, Cape Town.
Results. The mean gestational age for the entire cohort was 31±2 weeks. There were no significant differences between the
groups with regard to the need for MV in the first week of life. However, the duration of any form of assisted ventilation (NCPAP
and MV) was less in the low-threshold group (p=0.042), and this group had a lower mean PaCO2 at 24 hours (p=0.015).
Conclusions. In this pilot study, the administration of 100 mg/kg porcine surfactant to preterm infants with RDS requiring
NCPAP at a threshold FiO2 of 0.3 - 0.4 improved alveolar ventilation and reduced the duration of any form of assisted ventilation
compared with waiting until the FiO2 was >0.4. There was no significant reduction in the need for MV.