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Previous Volume 331:1051-1055 October 20, 1994 Number 16 Next

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ABSTRACT

Background In southern Scandinavia most babies with respiratory distress syndrome are initially treated with nasal continuous positive airway pressure. We performed a multicenter trial to investigate whether the addition of a single dose of porcine surfactant administered during a short intubation before the occurrence of serious deterioration could reduce the subsequent need for mechanical ventilation.

Methods We randomly assigned 35 infants with moderate-to-severe respiratory distress syndrome to surfactant therapy (Curosurf, 200 mg per kilogram of body weight) plus nasal continuous positive airway pressure and 33 infants to nasal continuous positive airway pressure alone. The study was not blinded. The indications for mechanical ventilation were a ratio of arterial to alveolar oxygen tension of less than 0.15, severe apneic attacks, or both.

Results Six hours after randomization, when the median age of the babies was 18 hours, the mean ratio of arterial to alveolar oxygen tension was 0.37 in the surfactant-treated babies, as compared with 0.25 in the controls (P<0.001). The need for subsequent mechanical ventilation was reduced with surfactant therapy (to 43 percent of the surfactant-treated babies, as compared with 85 percent of the controls; P = 0.003). When 17 infants with ratios of arterial-to-alveolar oxygen tension of less than 0.15 at randomization were excluded, the need for mechanical ventilation was still significantly reduced in the surfactant-treated group (to 33 percent [9 of 27 babies], as compared with 83 percent [20 of 24 babies] in the control group; P<0.001). After 28 days, two of the surfactant-treated babies had died, as compared with five of the control babies.

Conclusions In babies with moderate-to-severe respiratory distress syndrome treated with nasal continuous positive airway pressure, a single dose of surfactant reduced the need for subsequent mechanical ventilation.

Source Information

From the Department of Pediatrics, Holbaek Central Hospital, Holbaek, Denmark (H.V., P.A.); the Research Unit for Perinatal Pathology, Karolinska Hospital, Stockholm, Sweden (B.R.); the Department of Pediatrics, University Hospital of Copenhagen, Copenhagen, Denmark (G.G., K.L., T.J.); and the Department of Pediatrics, Aalborg Hospital, Aalborg, Denmark (F.E.). The members of the Danish-Swedish Multicenter Study Group are listed in the Appendix.

Address reprint requests to Dr. Verder at the Department of Pediatrics, Holbaek Central Hospital, 4300 Holbaek, Denmark.

Full Text of this Article

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