Surfactant treatment of neonates with respiratory failure and group B streptococcal infection

Objective. Connatal pneumonia caused by group B streptococcal (GBS) infecti on may be associated with surfactant dysfunction. We investigated the effec ts of surfactant treatment in term and preterm neonates with GBS infection and respiratory failure, in comparison with corresponding data from a contr ol population of noninfected infants heated with surfactant for respiratory distress syndrome (RDS). Design/Methods. The study comprised 118 infants with respiratory failure, c linical and/or laboratory signs of acute inflammatory disease, and GBS infe ction proven by culture results. They were recruited retrospectively from a database of patients treated with surfactant at 28 neonatology units parti cipating in European multicenter trials (1987-1993) and prospectively from the same units in the following years. A nonrandomized control group of 236 noninfected infants was selected from the same database. The primary param eters evaluated were oxygen requirement, ventilator settings, and incidence of complications. Results. Median birth weight in the GBS study group was 1468 g (25th-75th p ercentiles: 1015-2170), and median gestational age was 30 (27-33) weeks. Th irty-one percent of the infants weighed >2000 g. Median age at surfactant t reatment was 6 hours. The mean initial surfactant dose was 142 mg/kg (stand ard deviation: 53). Ninety of the infants were treated with Curosurf (Chies i Farmaceutici, Parma, Italy), 13 with Survanta (Abboth GmbH, Wiesbaden, Ge rmany), 12 with Alveofact (Dr Karl Thomae GmbH, Biberach, Germany), and 3 w ith Exosurf (Wellcome GmbH, Burgwedel, Germany). Within 1 hour of surfactan t treatment, median fraction of inspiratory oxygen was reduced from .84 (25 th-75th percentiles: .63-1.0) to .50 (.35-.80). The incidence of complicati ons in the study group (mortality: 30%; pneumothorax: 16%; intracranial hem orrhage: 42%) was high, compared with infants with RDS. Conclusions. Surfactant therapy improves gas exchange in the majority of pa tients with GBS pneumonia. The response to surfactant is slower than in inf ants with RDS, and repeated surfactant doses are often needed. The mortalit y and morbidity are substantial, considering the relatively high mean birth weight of the treated infants.