Early administration of the second dose of surfactant (beractant) in the treatment of severe hyaline membrane disease

The aim of this study was to demonstrate that administration of the second dose of beractant 2 h after the first one is more effective than 6 h after the initial dose. The inclusion criteria for the recruitment of newborn inf ants were: age less than or equal to8 h, birthweight 600-2000 g, gestationa l age 23-36 wk, need for mechanical ventilation with inspiratory oxygen fra ction (FiO(2)) greater than or equal to0.4 and mean airway pressure (MAP) g reater than or equal to7 cmH(2)O to obtain arterial oxygen tension (PaO2) v alues between 70 and 80 mmHg, and thoracic X-ray compatible with hyaline me mbrane disease (HMD). Newborns with major congenital malformations, hydrops fetalis or seven pulmonary hypoplasia, or being treated with high-frequenc y oscillatory ventilation were excluded. In total, 57 premature newborns we re studied. 20 of them below 1000 g, who received 100 mg kg(-1) of beractan t in 2 aliquots and showed an inadequate response, i.e, after 2 h of the fi rst dose the newborn still needed a FiO(2) greater than or equal to 0.4 and a MAP greater than or equal to 7 cmH(2)O to achieve a PaO2 > 70 mmHg. The second dose was randomly administered 2 or 6 h from the first one. Conclusion: The 2 study groups were comparable except for a higher need of dopamine and seroalbumin in 2-h group. Evolution and complications were sim ilar. Twelve hours after the first dose, the percentage improvement in the arteriolar/alveolar ratio (a/ADO(2)) in the 2-h group was similar to that i n the 6-h group. However, in newborns below 1000 g, 12 h after the first do se the a/ADO(2) percentage improvement in the 2-h group was greater than in 6-h group (median of 103.6% vs 16.3%; p = 0.035). In premature infants bel ow 1000 g, it seems reasonable to advance the second dose of beractant if n eeded.