Evaluation of the Need for Prophylactic Surfactant (PS) at 27-28 Weeks Gestation.

Zoe O. VanOrden, Meredith Monaco-Brown

Abstract


Objective:  Evaluate outcomes in 27-28 week gestation infants before and after a change in prophylactic surfactant guidelines.

Materials and Methods:  This retrospective chart review followed a change in NICU guidelines (January 2013) in which recommendations for prophylactic surfactant target population were changed from all infants under 29 weeks' to those under 27 weeks'.  All 27-28 week infants born 24 months before (PRE) and 24 months after (POST) the guideline change were searched by database. Demographic data and outcomes were evaluated using non-parametric ANOVA and Dunn's multiple comparisons test.

Results:   In a NICU where 92% of its 27-28 week neonates receive at least one dose of prenatal steroids, the groups differed in only two outcome measures:  surfactant doses and ventilator days after discontinuing prophylactic surfactant.

Conclusions:  This study suggests that there is no clear benefit and potential risk to prophylactic surfactant administration in 27-28 week gestation neonates.  More studies may be useful to redefine criteria (or need) for prophylactic surfactant.

Relevance:  As prenatal steroids for prevention of respiratory distress syndrome has become more prevalent, we may need to reassess the routine use of surfactant in extremely and very low birthweight infants.


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References


Hintz SR, Poole WK, Wright LL, Fanaroff AA, Kendrick DE, Laptook AR, et al. Changes in mortality and morbidities among infants born at less than 25 weeks during the post-surfactant era. Arch Dis Child Fetal Neonatal Ed. 2005;90(2):F128-133.

Hoekstra RE, Jackson JC, Myers TF, Frantz ID, Stern ME, Powers WF, et al. Improved neonatal survival following multiple doses of bovine surfactant in very premature neonates at risk for respiratory distress syndrome. Pediatrics. 1991;88(1):10-18.

Soll RF. Prophylactic synthetic surfactant for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2000(2):CD001079.

Rojas-Reyes MX, Morley CJ, Soll R. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2012;3:CD000510.

Polin RA, Carlo WA, Committee on F, American Academy of Pediatrics, Papile L, Tan R, et al. Surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics. 2014;133(1):156-163.

Lopez E, Gascoin G, Flamant C, Merhi M, Tourneux P, Baud O, et al. Exogenous surfactant therapy in 2013: what is next? Who, when and how should we treat newborn infants in the future? BMC Pediatr. 2013;13:165.


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