The objective of this study was to determine how the neonatal mortality rat
e has changed since surfactant (S) therapy was introduced in our Neonatal I
ntensive Care Unit (NICU), and to evaluate the efficacy of surfactant thera
py in respiratory distress syndrome (RDS) patients. Incidences of risk babi
es such as outborns, prematurity, low birth weight infants and RDS, and neo
natal mortality rates were compared between 'pre' (control, 1988 to 1991, n
=4,861) and 'post' S period (study, 1993 to 1996, n=5,430). In RDS patients
of 'post' S period, neonatal mortality rate was compared between S-treated
and non-treated patients, and chest X-ray and ventilatory parameters were
compared between pre- and post-72 hr of surfactant treatment. Surfactant th
erapy showed short term effects, judging by the decrease of early neonatal
deaths and improvement of chest X-ray and ventilatory parameters in RDS pat
ients, The overall neonatal mortality rate had a tendency to decrease in sp
ite of increased incidences of risk babies in 'post' S period but it was le
ss than expected. The reasons were thought to be that we had a high proport
ion of risk babies, and there was some bias in patient selection for surfac
tant therapy and its use. In conclusion, with the active prevention of risk
baby delivery and appropriate use of surfactant, better results could be e
xpected.