This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Osborn, D. A.
Right arrow Articles by Reid, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Osborn, D. A.
Right arrow Articles by Reid, S.
Related Collections
Right arrow Premature & Newborn

PEDIATRICS Vol. 106 No. 3 September 2000, p. e30

ELECTRONIC ARTICLE:
Targeted Early Rescue Surfactant in Ventilated Preterm Infants Using the Click Test

Received Dec 17, 1999; accepted Apr 14, 2000.

David A. Osborn*, Dagger , Heather E. Jeffery*, Dagger , Sandie L. Bredemeyer*, §, Jan M. Polverino*, and Shelley Reid*

From the * Department of Neonatology, Royal Prince Alfred Hospital; and the Dagger  Department of Obstetrics and Gynaecology and § Faculty of Nursing, University of Sydney, Camperdown, Australia.

Objective.  To determine whether use of the click test, a rapid bedside test of surfactant function, results in earlier and more appropriate surfactant administration in ventilated preterm infants than does usual early rescue treatment.

Study Design.  Ventilated preterm infants (n = 126) with inspired oxygen >= 25% and mean airway pressure >= 7 cm H2O were randomized in gestational strata (<28 weeks and 28-36 weeks) to have surfactant therapy determined by the click test or by usual clinical and chest radiograph criteria. The treatment group had the click test performed on a tracheal aspirate as soon as possible after intubation and, if negative or equivocal (surfactant deficient), surfactant was given. The control group had surfactant given as soon as possible based on clinical and chest radiograph diagnoses of respiratory distress syndrome.

Results.  In infants of <28 weeks' gestation, use of the click test resulted in significantly earlier surfactant therapy (median time: 50 vs 159 minutes) and a reduction in the number of infants receiving surfactant (48% vs 79%). In infants of 28 to 36 weeks' gestation, there was no difference in time to surfactant (median time: 300 vs 268 minutes) or in the number of infants receiving surfactant. Neonatal morbidity and mortality were similar in click test and control groups.

Conclusions.  Use of the click test in ventilated, extremely premature infants results in significantly earlier and more appropriately targeted administration of surfactant than does early rescue therapy based on clinical and radiograph criteria. A randomized trial of targeted early rescue surfactant therapy versus prophylactic surfactant therapy in infants of <28 weeks' gestation is warranted. The click test has the potential to improve clinical outcomes and reduce costs.  Key words:  click test, hyaline membrane disease, infant-premature, surfactant.




This article has been cited by other articles:


Home page
 Inj. Prev.Home page
M H Swahn, B J Hammig, and R M Ikeda
Prevalence of youth access to alcohol or a gun in the home
Inj. Prev., September 1, 2002; 8(3): 227 - 230.
[Abstract] [Full Text] [PDF]