Pilot study of nebulized surfactant therapy for neonatal respiratory distress syndrome

Thirty-four spontaneously breathing newborns with respiratory distress synd rome (RDS) requiring nasal continuous positive airway pressure (CPAP) and a n arterial-tu-alveolar oxygen tension ratio (a/A PO2) of 0.15-0.22 were ran domized to treatment with nebulized surfactant (Curosurf(R)) or to serve as controls. All children were first supported by nasal CPAP according to nor mal clinical routines. Surfactant was administered using a modified Aiolos( R) nebulizer. and a total of 480 mg was aerosolized in each case. The contr ol group received no nebulized material, but had the same CPAP support. Aci d-base status and a/A PO2 were determined at regular intervals before, duri ng and after surfactant administration. Both groups included in the study w ere similar with regard to gestational age, birthweight, steroids given bef ore birth, sex and Apgar scores as well as a/A PO2 when entering the study. There were no significant differences between the groups in a/A PO2 1-12 h after randomization, number of infants needing mechanical ventilation, tim e on ventilator or CPAP. Two children in the treated group developed bronch opulmonary dysplasia. No side effects of the surfactant therapy were noted. No beneficial effects of aerosolized surfactant were demonstrated in our tr ial, contrary to data from animal experiments. This finding probably reflec ts differences in administration techniques. Our findings do not justify la rge clinical trials with the same protocol. Further work is needed to optim ize delivery of aerosolized surfactant to the neonatal lung in clinical pra ctice.