INHALATION OF AEROSOLIZED SURFACTANT (EXOSURF(R)) TO NEONATES TREATEDWITH NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE

The aim of this pilot study was to estimate whether inhalation of aero solized synthetic surfactant in different dosages would improve system ic oxygenation in infants with mild to moderate respiratory distress s yndrome treated with nasal continuous positive airway pressure (CPAP). Twenty-two neonates with respiratory distress treated with nasal CPAP at a pressure of 4-8 cmH(2)O with fraction of inspired oxygen (FiO(2) ) 0.3-0.6 and arterio-alveolar oxygen tension ratio (a/A-ratio) > 0.2 were treated with aerosolized surfactant (Exosurf(R)) in a closed nasa l CPAP system. The infants were given two inhalations with 1 + 1, 2 2, 4 + 4, and 8 + 8 vials of Exosurf with 6-h interval. The gestationa l age was 23 3/7 to 36 5/7 weeks and the birth weight 540-2721 g. The delivered dose of aerosolized surfactant was estimated to be between h alf and four times the amount of surfactant in a newborn infant. Eight infants were intubated and mechanically ventilated either during or a fter the study period. Four of these infants were treated with additio nal endotracheal surfactant, but only one infant improved so much on t his treatment that persistent surfactant deficiency could be assumed. Overall, surfactant inhalation did not improve the a/A-ratio. There wa s no significant dependency between the a/A-ratio response and the dos e of Exosurf, the gestational age or the a/A-ratio before the first in halation in the study group.