GESTATIONAL-AGE CAN PREDICT THE NEED FOR PROPHYLAXIS WITH SURFACTANT THERAPY

Controversy exists as to whether prophylactic or rescue therapy with s urfactant should be used in infants born at less than 30 weeks gestati on. We developed the hypothesis that gestational age can be used to pr edict a need for prophylactic surfactant therapy. We designed this ret rospective study to determine whether there was a gestational age belo w which one could accurately predict the need for prophylactic surfact ant therapy in almost all infants and limit unnecessary treatment of i nfants. We conducted a retrospective study of infants born at 23-34 we eks' gestation to determine the frequency with which surfactant therap y was used in a rescue strategy at each gestational age, and to ascert ain the sensitivity, specificity, and predictive values of gestational age as a predictor of the use of surfactant therapy. There was a sign ificant inverse correlation between gestational age and the proportion of infants treated with surfactant (r = -0.923, p < 0.001). A gestati onal age cut-off of 26 completed weeks' had a positive predictive valu e of 85% and a specificity of 96% for the need for surfactant therapy. We conclude that gestational age can be used to predict a need for su rfactant therapy in premature infants. At our institution, the failure to attain 26 completed weeks' gestation will accurately predict the n eed for surfactant therapy and will result in unnecessary treatment of very few infants. We suggest that each institution caring for very lo w birth weight infants should examine its population to determine the gestational age at which they can accurately predict the need for prop hylaxis with surfactant therapy.