SURFACTANT REPLACEMENT IN NEONATES WITH EARLY CHRONIC LUNG-DISEASE

Objective. To study the effect of a single dose of exogenous bovine su rfactant on oxygen and ventilatory requirements of neonates with early chronic lung disease. Study design. Prospective pilot study. Setting. Three regional neonatal intensive care units. Methods. Infants 7 to 3 0 days old with birth weights less than 1500 g were eligible if they r equired a fraction of inspired oxygen (FIO2) of more than 0.4, had sta ble ventilatory requirements for 24 hours before study entry, and show ed diffuse haziness on chest radiographs. Those with patent ductus art eriosus or active infection or those receiving steroid therapy were ex cluded. After treatment with the surfactant, differences in FIO2 and t he ventilator efficiency index were analyzed using the Wilcoxon signed rank test. Results. Ten patients were recruited. Median values (range ): birth weight, 693 g (530 to 1100 g); gestation, 25 weeks (24 to 27 weeks); and postnatal age at study entry, 13 days (9 to 30 days). The FIO2, decreased significantly between 0 and 1 hour after surfactant ad ministration, from a median (range) of 0.67 (0.47 to 0.88) to 0.39 (0. 28 to 0.63). This effect was sustained for 24 hours (median FIO2, 0.36 ). Although the FIO2 subsequently increased to 0.49 (range, 0.35 to 0. 88) at 72 hours, it was significantly lower than that entry before the study. There was a trend toward an increase in the ventilator efficie ncy index at 24 and 48 hours. Conclusions. A single dose of surfactant is effective in reducing oxygen requirements in neonates with early c hronic lung disease. Surfactant replacement may be useful adjunctive t herapy in these neonates.