Early Surfactant Administration with Less Invasive Techniques Prevents Continuous Positive Airway Pressure Failure in Very Preterm Newborns

Introduction Influence of different timing and methods of surfactant administration on the clinical outcomes in very preterm (VP) infants with respiratory distress syndrome (RDS) are yet to be investigated. The aim of this study was to evaluate the impact of earlier surfactant administration on clinical outcomes and the incidence of continuous positive airway pressure (CPAP) failure defined as the need for mechanical ventilation (MV) during the first 5 days of life.

Materials and Methods One hundred sixty-five outborn VP (<32 weeks) infants with RDS, who were treated with CPAP after birth, were involved into a prospective cohort study. Fifty-two infants treated with surfactant using less invasive (LISA) or INSURE techniques were included into the surfactant group. One hundred thirteen control infants were initially managed on CPAP and received surfactant only in case of CPAP failure after intubation on MV.

Results The study groups were similar in terms of gestational age and antenatal steroid prophylaxis. Rate of cesarean delivery was significantly higher (69 vs. 51%, p < 0.05) and birthweight was lower (1,050.48 ± 243.13 vs. 1,173.76 ± 227.46 g, p < 0.01) in infants from the surfactant group. Total 13 (25%) newborns in the surfactant group needed resuscitation at birth as compared with 48 infants (42%) in the control group (p < 0.05). All 55 babies with CPAP failure (49%) received surfactant after initiation of MV in the control group in comparison with all 52 (100%) newborns in the surfactant group (p < 0.001). The incidence of CPAP failure was significantly higher in the control group (49 vs. 27%, p < 0.01) and it occurred earlier (4 [2–5] vs. 47 [36–99] hours, respectively; p < 0.001). There were no differences in major perinatal morbidity between the groups. According to the results of multivariate LRA, early surfactant administration reliably and independently affected the probability of CPAP failure (odds ratio: 0.29, 95% confidence interval: 0.13–0.67, p < 0.01). At the same time, CPAP failure was significantly associated with higher incidence of severe intraventricular hemorrhages, pneumothoraxes, bronchopulmonary dysplasia (BPD), death, and lower probability of survival without BPD.

Conclusion Early rescue surfactant administration in VP infants decreases the probability of CPAP failure which is significantly associated with higher morbidity and mortality.

Conflict of Interest

None declared.