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PEDIATRICS Vol. 106 No. 5 November 2000, pp. 957-964

Surfactant Treatment of Neonates With Respiratory Failure and Group B Streptococcal Infection

Received Jul 6, 1999; accepted Feb 16, 2000.

Egbert Herting*, parallel , Olaf GefellerDagger , Matthias LandDagger , Loekie van Sonderen§, Karsten Harms*, Bengt Robertsonparallel , and Members of the Collaborative European Multicenter Study Group

From the * Departments of Pediatrics, University of Göttingen, Göttingen, Germany; Dagger  Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Nuremberg, Germany; § Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands; and the parallel  Division for Experimental Perinatal Pathology, Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden.

Objective.  Connatal pneumonia caused by group B streptococcal (GBS) infection may be associated with surfactant dysfunction. We investigated the effects of surfactant treatment in term and preterm neonates with GBS infection and respiratory failure, in comparison with corresponding data from a control population of noninfected infants treated with surfactant for respiratory distress syndrome (RDS).

Design/Methods.  The study comprised 118 infants with respiratory failure, clinical and/or laboratory signs of acute inflammatory disease, and GBS infection proven by culture results. They were recruited retrospectively from a database of patients treated with surfactant at 28 neonatology units participating in European multicenter trials (1987-1993) and prospectively from the same units in the following years. A nonrandomized control group of 236 noninfected infants was selected from the same database. The primary parameters evaluated were oxygen requirement, ventilator settings, and incidence of complications.

Results.  Median birth weight in the GBS study group was 1468 g (25th-75th percentiles: 1015-2170), and median gestational age was 30 (27-33) weeks. Thirty-one percent of the infants weighed >2000 g. Median age at surfactant treatment was 6 hours. The mean initial surfactant dose was 142 mg/kg (standard deviation: 53). Ninety of the infants were treated with Curosurf (Chiesi Farmaceutici, Parma, Italy), 13 with Survanta (Abboth GmbH, Wiesbaden, Germany), 12 with Alveofact (Dr Karl Thomae GmbH, Biberach, Germany), and 3 with Exosurf (Wellcome GmbH, Burgwedel, Germany). Within 1 hour of surfactant treatment, median fraction of inspiratory oxygen was reduced from .84 (25th-75th percentiles: .63-1.0) to .50 (.35-.80). The incidence of complications in the study group (mortality: 30%; pneumothorax: 16%; intracranial hemorrhage: 42%) was high, compared with infants with RDS.

Conclusions.  Surfactant therapy improves gas exchange in the majority of patients with GBS pneumonia. The response to surfactant is slower than in infants with RDS, and repeated surfactant doses are often needed. The mortality and morbidity are substantial, considering the relatively high mean birth weight of the treated infants.  Key words:  pediatrics, group B streptococci, pneumonia, pulmonary surfactant, infants, neonates.




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GBS randomization
Renato S Procianoy
Pediatrics Online, 7 Nov 2000 [Full text]
Answer to Dr Procianoy
Egbert Herting
Pediatrics Online, 25 Nov 2000 [Full text]