EFFECT OF NEONATAL SURFACTANT THERAPY ON LUNG-FUNCTION AT SCHOOL-AGE IN CHILDREN BORN VERY PRETERM

Our aim was to evaluate long-term effects of exogenous surfactant ther apy on pulmonary functional outcome in children born very preterm. We examined 40 children aged 7-12 years who were born before 30 weeks of gestation with an immature surfactant system, and were randomized to o ne of three treatment groups: human surfactant given at birth (prophyl actic), human surfactant given after development of neonatal respirato ry distress syndrome (rescue), and placebo (air) treatment. Spirometri c parameters of preterm born children were compared with those of 20 c hildren born at term. In addition, spirometric parameters were monitor ed twice daily for 4 weeks using a home spirometer. All spirometric pa rameters were significantly lower in the preterm groups than in the co ntrols, except for the forced vital capacity (FVC) in the prophylactic ally treated group. Bronchial obstruction was found in 53% of the prop hylactically treated group, in 36% of the rescue group, in 67% of the placebo group, and in 0% of the control group. Peak expiratory flow (P EF) and FVC values were higher in those children who received surfacta nt compared with the placebo group (P < 0.05). In 16 children (40%) bo rn preterm, a beta(2)-agonist induced an increase in PEF greater than or equal to 15% at least three times during 2 weeks of home monitoring ; eight children (20%) had abnormal diurnal PEF variation. Multiple re gression analysis indicated that the independent variables associated with favorable outcomes in spirometric parameters were surfactant ther apy (P = 0.012-0.045) and short intubation time after birth (P = 0.000 9-0.0044). Bronchial obstruction, responsiveness to a beta(2)-agonist, and high diurnal PEF variation are common in children born before 30 gestational weeks. Surfactant supplementation reducing the need for me chanical ventilation or supplementary oxygen after birth may decrease the severity of immaturity related bronchial obstruction in childhood. (C) 1998 Wiley-Liss, Inc.