RESPIRATORY-DISTRESS-SYNDROME IN NEW-ZEALAND - EVIDENCE FROM THE OSIRIS TRIAL OF EXOGENOUS SURFACTANT (EXOSURF)

Aims. To assess the impact, mortality, morbidity and economic costs, o f respiratory distress syndrome severe enough to warrant ventilation i n one year in New Zealand. Methods. Review of data from all five New Z ealand regional neonatal intensive care units' participation in the in ternational OSIRIS trial of exogenous surfactant (Exosurf) treatment f or respiratory distress syndrome (involving 6700 infants in 21 countri es), and extrapolation of these data to a full year. Results. There we re 265 New Zealand infants entered in the OSIRIS trial; the mean birth weight was 1335 g and mean gestation 29 weeks; 61% of infants were les s than 30 weeks gestation. Forty-seven infants (17.7%) died prior to d ischarge from hospital, 40 deaths being attributed to prematurity or r espiratory distress syndrome. One hundred and two infants (38.5% of th e cohort; 45% of surviving infants) were oxygen dependent and 36 infan ts (13.6%) were dead at 28 days of age. Thirty-four infants (12.8% of the cohort; 15% of surviving infants) were oxygen dependent and 40 inf ants (15%) were dead at the expected date of delivery. Infants were in tubated for a mean 12.5 days, with surviving infants of less than 27 w eeks gestation intubated for a disproportionately long period of time. Seventy-two infants (29% of the 246 infants examined) had an abnormal ity detected by cranial ultrasound scan at 1 or 6 weeks of age and in 23 (9%) this was a major abnormality. Of surviving infants 16 (7.5% of 213 examined) had a major abnormality on cranial ultrasound scan. Amo ngst infants at high risk for respiratory distress syndrome (gestation less than 30 weeks) 53% received antenatal steroids, compared with 22 % in the OSIRIS trial overall. In a full year the cost of caring for i nfants with respiratory distress syndrome sufficiently severe enough t o warrant ventilation is estimated to be NZ$12.5 million. The average cost of caring for a surviving infant was roughly NZ$52 500 and a nons urviving infant was NZ$24 500. Conclusions. In a full year (total birt hs 60 000) approximately 350 New Zealand infants may require ventilati on for respiratory distress syndrome. Increasing the percentage of inf ants who receive antenatal steroids is likely to be extremely cost eff ective. In the era of antenatal steroids and exogenous surfactant, 85% of infants with respiratory distress syndrome requiring ventilation s urvive to discharge home and over 90% of survivors are likely to be he althy normal adults.