DECREASING MORTALITY ASSOCIATED WITH THE INTRODUCTION OF SURFACTANT THERAPY - AN OBSERVATIONAL STUDY OF NEONATES WEIGHING 601 TO 1300 GRAMSAT BIRTH

Objective. To determine whether the introduction of surfactant therapy was associated with decreased mortality for high-risk preterm neonate s weighing 601 to 1300 g at birth. Design. Before-after observational study. Setting. Eight tertiary care neonatal intensive care units part icipating in the National Institute of Child Health and Human Developm ent Neonatal Research Network. Patients. The outcomes for neonates wit h birth weight 601 to 1300 g admitted in the 2 years before surfactant s became available (n = 2780) were compared with those of neonates adm itted in the year beginning 2 months after surfactants became availabl e (n = 1413). Main outcome measures. The primary outcome measure was i n-hospital mortality; secondary outcome measures included durations of assisted ventilation, length of hospitalization, and neonatal morbidi ty. Results. Forty percent of neonates in the postsurfactant group rec eived surfactant (range 28% to 69% at the centers). Mortality decrease d from 27.8% before to 19.9% after surfactant therapy was introduced ( Mantel-Haenszel chi2 = 31.4, P = .001). The adjusted odds ratio for mo rtality after surfactants became available was 0.73 (95% confidence in terval 0.55 to 0.95). The duration of assisted ventilation and length of hospitalization increased after surfactants were introduced (P = .0 001 for both outcomes). Conclusion. Mortality for neonates weighing 60 1 to 1300 g decreased after surfactant therapy was introduced, suggest ing that the efficacy of surfactants demonstrated in randomized contro lled trials will translate into effectiveness in routine clinical care .