EFFECTS OF SURFACTANT THERAPY ON OUTCOME OF EXTREMELY PREMATURE-INFANTS

Limits of viability of extremely premature infants have recently been addressed both in Europe and the United States. These reports, which d emonstrate frequent adverse outcome of infants born before 26 weeks of gestation, have not considered the impact of surfactant therapy. We r eviewed records of 445 infants born between 23 and 36 weeks gestation who were admitted to our nursery following the availability of surfact ant treatment in 1986 through 1992. Two hundred and eighty-five infant s were treated with surfactant (Survanta, Ross Laboratories) as part o f controlled, prospective trials or as routine treatment under Food an d Drug Administration approval. One hundred and fifty-six infants were unable to be treated with surfactant, as either they received placebo therapy during prospective trials or were born prior to approval of r outine surfactant use in the United States. Four additional infants ba rn following the commercial availability of surfactant did not receive surfactant therapy. Survival of untreated infants was 56% compared to 75% in treated infants (P<0.001). Infants born at all gestational age s between 23 and 26 weeks had an increased likelihood of survival as a result of surfactant treatment. No differences in neurologic outcome between surfactant treated and non-treated infants were demonstrated a t subsequent follow-up. We conclude that survival of extremely prematu re infants is improved following surfactant therapy and that subsequen t neurologic outcome is not compromised as a result of this therapy.