PEDIATRICS Vol. 76 No. 4 October 1985, pp. 593-599
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Double-Blind, Randomized Trial of a Calf Lung Surfactant Extract Administered at Birth to Very Premature Infants for Prevention of Respiratory Distress Syndrome

Donald L. Shapiro MD1, Robert H. Notter PhD, MD1, Frederick C. Morin III MD1, Karl S. Deluga MD1, Leonard M. Golub MD1, Robert A. Sinkin MD1, Kerry I. Weiss MD1, and Christopher Cox PhD1

1 From the Department of Pediatrics (Neonatology) and the Division of Biostatistics, University of Rochester School of Medicine, Rochester, New York

Organic solvent extraction of surfactant obtained by lavage of calf lungs yields a highly surfaceactive material. A double blind, randomized clinical trial to determine the effect of this material on respiratory distress syndrome in premature infants was initiated in the Neonatal Intensive Care Unit at the University of Rochester in December 1983. Infants 25 to 29 weeks gestational age were eligible for entry into the trial. At the time of this interim analysis 32 patients had been randomly selected and entered into the trial, 16 surfactant-treated patients and 16 in a control group who received only saline. At birth, intrapulmonary instillation of the calf lung surfactant extract dispersed in saline or saline alone occurred in the delivery room immediately after intubation and prior to ventilation; infants were then ventilated and treated as usual. At 6, 12, 24, 48, and 72 hours after birth, the severity of respiratory distress was categorized as either minimal, intermediate, or severe based on oxygen and mean airway pressure requirements. Differences observed at six hours after birth were of marginal significance, but at 12 and 24 hours the surfactant-treated group had significantly (P < .01) less severe respiratory distress compared with the control group. Differences between treated and control infants were not statistically significant at 48 and 72 hours after birth. In four surfactant-treated infants the severity of respiratory distress worsened between 24 and 48 hours after birth, suggesting that one dose of surfactant at birth may not be sufficient for some infants.

Key Words: surfactant replacement therapy • respiratory distress syndrome • lung • premature infants • toxicity

Submitted on June 3, 1985
Accepted on June 28, 1985




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