ANTEPARTUM PROPHYLAXIS AND POSTNATAL THER APY OF RESPIRATORY-DISTRESSSYNDROME

The introduction of surfactant in the therapy of respiratory distress syndrome (RDS) reduced mortality and long term complications in very p remature infants. Nevertheless, the obstetric management influences cr itically the outcome. In a prospective study of 116 premature infants with RDS treated with natural surfactant preparations after birth, mor tality was significantly reduced by antepartum corticosteroid therapy suggesting a synergistic effect of corticosteroids and surfactant on t he immature lung. It is assumed that a preventive administration of su rfactant immediately after birth would benefit neonates at risk for RD S more than a delayed surfactant replacement after the development of RDS. But without a reliable assessment of fetal lung maturity before b irth more than 50% of our premature infants with birth weights less th an 1500 g would be exposed to surfactant unnecessarily. It is importan t that fetal asphyxia is avoided. Acquired respiratory distress syndro me occur even in premature infants after shock or meconium aspiration and may respond poorly to surfactant replacement. This is also the cas e in lung hypoplasia or perinatal infection, where the combined effort s of obstetricians and neonatologists are needed to attain better resu lts.