SURFACTANT THERAPY AND NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE FOR NEWBORNS WITH RESPIRATORY-DISTRESS SYNDROME

Background. In southern Scandinavia most babies with respiratory distr ess syndrome are initially treated with nasal continuous positive airw ay pressure. We performed a multicenter trial to investigate whether t he addition of a single dose of porcine surfactant administered during a short intubation before the occurrence of serious deterioration cou ld reduce the subsequent need for mechanical ventilation. Methods. We randomly assigned 35 infants with moderate-to-severe respiratory distr ess syndrome to surfactant therapy (Curosurf, 200 mg per kilogram of b ody weight) plus nasal continuous positive airway pressure and 33 infa nts to nasal continuous positive airway pressure alone. The study was not blinded. The indications for mechanical ventilation were a ratio o f arterial to alveolar oxygen tension of less than 0.15, severe apneic attacks, or both. Results. Six hours after randomization, when the me dian age of the babies was 18 hours, the mean ratio of arterial to alv eolar oxygen tension was 0.37 in the surfactant-treated babies, as com pared with 0.25 in the controls (P<0.001). The need for subsequent mec hanical ventilation was reduced with surfactant therapy (to 43 percent of the surfactant-treated babies, as compared with 85 percent of the controls; P = 0.003). When 17 infants with ratios of arterial-to-alveo lar oxygen tension of less than 0.15 at randomization were excluded, t he need for mechanical ventilation was still significantly reduced in the surfactant-treated group (to 33 percent [9 of 27 babies], as compa red with 83 percent [20 of 24 babies] in the control group; P<0.001). After 28 days, two of the surfactant-treated babies had died, as compa red with five of the control babies. Conclusions. In babies with moder ate-to-severe respiratory distress syndrome treated with nasal continu ous positive airway pressure, a single dose of surfactant reduced the need for subsequent mechanical ventilation.