RADIOLOGICAL CHANGES AFTER SURFACTANT REP LACEMENT THERAPY - RESULTS OF A RANDOMIZED EUROPEAN MULTICENTER CUROSURF TRIAL

343 preterm infants treated with either single or multiple doses of th e natural surfactant preparation Curosurf had chest X-rays immediately before and 12 hours after initiation of therapy. There were no differ ences in the baseline characteristics of both treatment groups or radi ological disease severity. Before surfactant replacement about 90% of patients showed severe respiratory distress syndrome grade III or IV o n their chest-X-ray, 12 hours later only 14% logistic regression analy sis showed good correlation of radiological severity of respiratory di stress syndrome before therapy with neonatal morbidity and mortality. Patients with initially radiological severity grade IV of respiratory distress syndrome had an increased risk of pulmonary interstitial emph ysema, pneumothorax, intracranial hemorrhage and death. Especially bab ies with severe radiological findings profited from multiple-dose trea tment with surfactant; mortality was reduced from 46% to 19% in these patients. In a subgroup additional radiograph of 35 patients were anal ysed. An asymmetric appearance of respiratory distress syndrome after surfactant therapy - as an expression of uneven distribution of surfac tant in the lung - was observed on 20% of X-rays. This finding was not associated with relevant clinical problems. In addition a hazy, ''opa que'' lung during weaning from respiratory support was temporarily see n in 84% of the infants; this phenomenon was not predictive for the de velopment of bronchopulmonary dysplasia. In summary the therapeutic re sponse to surfactant replacement therapy is reflected by radiological changes in respiratory distress syndrome. Radiological severity of res piratory distress syndrome before therapy showed a good correlation wi th neonatal morbidity and mortality. Asymmetric appearance of respirat ory distress syndrome was not associated with relevant clinical proble ms.