Level 1: Likely reliable evidence
Treatment with surfactant has been shown to reduce mortality in newborns with respiratory distress syndrome. In these patients, surfactant is usually given via endotracheal intubation during mechanical ventilation. Infants born prematurely are at increased risk of respiratory distress. A randomized trial evaluated a new, minimally invasive approach for giving surfactant to preterm infants with increased oxygen requirements (Lancet. 2011;378:1627-1634).
A total of 220 spontaneously breathing preterm infants (gestational age 26-28 weeks; birth weight <1.5 kg) were randomized to surfactant plus standard treatment vs. standard treatment alone. All infants were stabilized with continuous positive airway pressure (CPAP) and had rescue intubation and mechanical ventilation if necessary. In the surfactant group, infants who were spontaneously breathing and stable on CPAP but also required >30% supplemental oxygen had surfactant administered via a thin catheter inserted into the trachea by laryngoscopy.
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Addition of surfactant reduced the need for mechanical ventilation on day 2 or 3 of life (28% vs. 46%, p=0.008, NNT 6) and during the entire hospital stay (33% vs. 73%, P<0.0001, NNT 3). The median duration of ventilation was 0 days for the surfactant group and 2 days for the usual-treatment group (P<0.05). Need for supplemental oxygen at 28 days was significantly lower in the surfactant group (30% vs. 45%, P=0.032, NNT 7). There were no significant differences in mortality or serious adverse events.
Alan Ehrlich, MD, is a deputy editor for DynaMed, in Ipswich, Mass., and assistant clinical professor in Family Medicine, University of Massachusetts Medical School in Worcester.
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