Changes of neonatal mortality rate between 'pre' and 'post' surfactant period

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.