Nasal continuous positive airway pressure and early surfactant therapy forrespiratory distress syndrome in newborns of less than 30 weeks' gestation

Objective. To determine whether early versus late treatment with porcine su rfactant (Curosurf) reduces the requirement of mechanical ventilation in ve ry preterm infants primarily supported by nasal continuous positive airway pressure (nasal CPAP). Design. Multicenter randomized, controlled trial. Patients. The study population comprised 60 infants <30 weeks' gestation wi th respiratory distress syndrome (RDS) who had an arterial to alveolar oxyg en tension ratio (a/APO(2)) of 0.35 to 0.22. The cohort from which the study population was generated comprised 397 infa nts. Results. The need for mechanical ventilation or death within 7 days of age was reduced from 63% in the late-treated infants to 21% in early-treated in fants. Increasing numbers of antenatal steroid doses also improved the outc ome, especially in the early-treated infants. Six hours after randomization mean a/APO(2) rose to 0.48 in the early-treated infants compared with 0.36 in the late-treated. The need of mechanical ventilation before discharge w as reduced from 68% in the late-treated to 25% in the early-treated infants . Conclusions. Nasal CPAP in combination with early treatment with Curosurf s ignificantly improves oxygenation and reduces the subsequent need for mecha nical ventilation in infants <30 weeks' gestational age with RDS.