EXOGENOUS SURFACTANT USE IN NEONATES

OBJECTIVE: To review exogenous surfactant use in the treatment of resp iratory distress syndrome (RDS) in premature neonates. DATA SOURCES: A MEDLINE search and extensive review of journals was conducted to iden tify the information for this review from 1983 to 1995 using the follo wing key words: prematurity, surfactant, clinical trials, beractant, S urvanta, colfosceril, Exosurf, and neonatal respiratory distress syndr ome. STUDY SELECTION AND DATA EXTRACTION: All articles were considered for possible inclusion in the review. Emphasis was placed on controll ed studies involving beractant and colfosceril palmitate. DATA SYNTHES IS: Results of published clinical trials using beractant or colfosceri l palmitate in premature infants at risk for RDS have shown improvemen t in the need for supplemental oxygen and ventilatory support over the course of RDS and a reduction in pneumothorax. However, there was lit tle impact on the incidence of intraventricular hemorrhage. Clinical t rials studying the treatment of established RDS have also shown simila r improvements. in a comparison of prophylactic versus late treatment, no distinct advantage of preventive treatment was found, except among infants less than 26-28 weeks gestation. Single- versus multiple-dose studies have shown no specific advantage of more than two doses of co lfosceril palmitate. A comparison trial of beractant and colfosceril p almitate has shown no difference in outcome. Long-term follow-up studi es have been encouraging among infants being treated with exogenous su rfactant. CONCLUSIONS: The use of beractant and colfosceril palmitate in premature infants has clearly decreased morbidity and mortality ass ociated with RDS. Only one trial has compared the efficacy of beractan t with that of colfosceril in the treatment of RDS, There does not app ear to be a distinct advantage of one product over another. Early trea tment of infants at highest risk for RDS, those less than 26-28 weeks gestation, seems to be beneficial over waiting for RDS to progress in severity. Further research needs to be performed to determine the opti mal dosing and timing of these agents, as well as comparative trials s tudying efficacy. Criteria for use of these products need to be furthe r defined to decrease the incidence of unnecessary treatment.