Surfactant replacement therapy

[Prenatal corticosteroid and early surfactant therapy in infants born at < or = 30 weeks gestation]

BACKGROUND

Prenatal corticosteroid (PNC) exposure and postnatal surfactant therapy improve outcome in very low birth weight infants (VLBWI). However, the efficacy of PNC in the prevention of chronic lung disease is debated.

OBJECTIVE

To study the effects of PNC exposure on outcome in VLBWI born at < or = 30 weeks' gestation.

PATIENTS AND METHODS

We performed a multicenter, longitudinal study. The Spanish Surfactant Group database (n 5 1,275) was searched and 211 VLBWI born at < or = 30 weeks who received early surfactant therapy (< or = 30 min) were identified. Perinatal events, neonatal management and rates of mortality and complications were evaluated. Data on the subgroup of infants who received PNC (157, 74.4 %) were compared with data on 54 infants who did not receive this therapy.

RESULTS

Mean (+/- SD) birth weight and gestational age were 944 (226) g and 27 (1.8) weeks. Surfactant was given at 16 +/- 13 min (61 % < or = 15 min). A total of 124 infants (58.8 %) developed respiratory distress syndrome. No differences were found in birth weight, gestational age, or Apgar score at 1 and 5 min. However the age at first surfactant dose was lower in infants exposed to PNC. PNC-exposed infants required fewer doses of surfactant, were extubated earlier (58.9 vs. 161 h) and needed a lower FiO2 at 48 h (0.28 vs. 0.35). Moreover, neonatal mortality (15.9 vs. 27.8 %), the incidence of intraventricular hemorrhage (25.2 vs. 50 %), ductus arteriosus (40.3 vs. 63.5 %) and necrotizing enterocolitis (9 vs. 19.2 %) were lower in infants receiving PNC. However, the incidence of chronic lung disease was similar in both groups.

CONCLUSIONS

PNC exposure of VLBWI born at < or = 30 weeks receiving early surfactant therapy reduced mortality and the incidence of certain complications but did not decrease the incidence of chronic lung disease.

Vitamin A status in preterm neonates with and without chronic lung disease

It has been proposed that there is an association between vitamin A (VA) deficiency and the development of chronic lung disease (CLD) in preterm infants. This study was designed to measure the VA status in preterm infants and to compare the results in the group of babies who developed CLD with the group who did not. Vitamin A status was assessed by measuring plasma VA, retinol binding protein (RBP) and the plasma VA:RBP molar ratio in 25 infants of less than 31 weeks gestation during the first 28 days of life. Eleven babies developed CLD and 14 did not. There was no significant difference in plasma VA levels between the CLD and non CLD groups during the first 28 days. The majority of infants had adequate VA status, with a subgroup being deficient.