EFFICACY OF SURFACTANT THERAPY IN INFANTS MANAGED WITH CPAP

Surfactant rescue therapy can be utilized effectively early in the cou rse of respiratory distress syndrome (RDS) in infants weighing > 1,000 g and treated exclusively with continuous positive airway pressure (C PAP) therapy. Thirteen infants (BW, 1,774 +/- 580 g; GA, 31 +/- 3 week s) comprising the CPAP/SURFACTANT group were compared with 12 infants (BW, 1,753 +/- 556 g; GA, 31 +/- 2 weeks) who comprised the intermitte nt mandatory ventilation (IMV)/surfactant group, and with 14 infants ( BW, 1,776 +/- 332 g; GA, 32 +/- 2 weeks) treated with CPAP before surf actant was clinically available. A 5 mL/kg dose of Exosurf Neonatal (B urroughs-Wellcome) was administered to infants intratracheally when th e FiO2 requirement reached 0.40 to maintain the PO2 above 50 torr. Inf ants in the CPAP/surfactant group were intubated solely for surfactant administration and extubated within 18 +/- 6 min of treatment. The CP AP/surfactant group was treated at a mean age of 12.3 +/- 9.3 h, and t he IMV/surfactant group at 10.2 +/- 9.8 h. Alveolar-arterial oxygen gr adient (AaDO(2)), oxygenation index (OI), and mean airway pressure (MA P) were determined immediately before and after surfactant therapy, an d at comparable times for the CPAP-only group. A significant differenc e was found in pre-treatment AaDO(2), OI, and MAP between the CPAP/sur factant group and IMV/surfactant group, but not between the CPAP/surfa ctant group and the CPAP-only group. Similarly, a significant differen ce in AaDO(2), OI, and MAP continued posttreatment was noted. However, a significant difference was also found at this time between the CPAP /surfactant group and the CPAP-only group. In addition, a significant difference was noted in AaDO(2) and OI pre- and post-treatment within each surfactant-treated group. Furthermore, in the CPAP-only group AaD O(2) and OI actually worsened (212 +/- 70 vs. 239 +/- 68; 4.0 +/- 1 vs . 4.5 +/- 2, respectively). There was a significant reduction in the d uration of oxygen therapy (3 +/- 2 vs. 5 +/- 2 vs. 4.5 +/- 2 days, res pectively) as well as in the total days of hospitalization (30 +/- 10 vs. 42 +/- 15 vs. 43 +/- 12 days, respectively). We conclude that in t his small group of infants surfactant administration was effective and safe. It appeared to improve the course of RDS and shorten the durati on of oxygen exposure and days of hospitalization. (C) 1995 Wiley-Liss , Inc.