PEDIATRICS Vol. 92 No. 6 December 1993, pp. 768-774
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Comparison of Prophylaxis and Rescue Treatment With Curosurf in Neonates Less than 30 Weeks' Gestation: A Randomized Trial

Johannes Egberts PhD1, J. Peter de Winter MD2, Gunnar Sedin MD3, Martin J.K. de Kleine MD4, Ulf Broberger MD5, Frank van Bel MD2, Tore Curstedt MD6, and Bengt Robertson MD7

1 From the Departments of Obstetrics and Gynecology, University of Leiden, the Netherlands
2 From the Department of Pediatrics, Division of Neonatology, University of Leiden, the Netherlands
3 From the Department of Department of Pediatrics, Uppsala University, Sweden
4 From the Department of Division of Neonatology, St. Joseph Hospital Veldhoven, the Netherlands
5 From the Department of Pediatrics, Karolinska Hospital Stockholm, Sweden
6 From the Department of Clinical Chemistry, Karolinska Institute, Danderyd Hospital, Danderyd, Sweden
7 From the Research Unit for Experimental Perinatal Pathology, Karolinska Institute, St. Göran's Childrens Hospital, Stockholm, Sweden

Objective. The aim of this randomized clinical trial was to evaluate the immediate effects of prophylactic administration of Curosurf and to compare outcomes after prophylactic or expectant management.

Study design. Porcine surfactant (Curosurf, 200 mg/kg body weight) was administered intratracheally within 10 minutes of birth to preterm neonates with a gestational age of 26 to 29 weeks (n = 75); rescue-eligible neonates (n = 72) were initially subjected to a sham maneuver. The primary end points of the trial, evaluated at the age of 6 hours, were to obtain (1) a 40% decrease in the ratio between transcutaneous oxygen tension (tcPo2) (kPa) and fraction of inspired oxygen (Fio2), and (2) a 50% decrease in the incidence of radiologically verified respiratory distress syndrome (RDS). After 6 to 24 hours, a similar dose of surfactant was given to the neonates of both the prophylaxis and the rescue-eligible group, if they needed mechanical ventilation with an Fio2 ge 0.6.

Results. At 6 hours the prophylaxis group had, in comparison with the rescue-eligible group, significantly higher tcPo2/Fio2 ratios (mean ± SD: 39.7 ± 15.3 vs 28.1 ± 18.1; P < .001) and less severe RDS by radiological scoring (khgr2 = 14.9; P = .005). Severe RDS was present in 19% of the prophylactically treated neonates versus 32% in the rescue-eligible group (P < .05). The prophylaxis group needed shorter periods of Fio2 > 0.40 than the rescueeligible neonates (P < .01), and eight neonates of the prophylaxis group (11%) versus 23 of the rescue-eligible group (32%) qualified for rescue treatment with surfactant in the interval 6 to 24 hours (P < .01). There were no differences in the incidence or severity of pneumothorax, pulmonary interstitial emphysema, cerebral hemorrhage, periventricular leukomalacia, patent ductus arteriosus, in the duration of mechanical ventilation or time in supplemental oxygen, or in mortality.

Conclusions. Subgroup analysis revealed (1) that administration of corticosteroids reduced the risk of developing neonatal RDS as effectively as did surfactant prophylaxis at birth, and (2) that prophylaxis was effective especially in neonates with gestational age <28 weeks or birth weight <1000 g, in male neonates, and in neonates who had received no antenatal treatment with corticosteriods. Our data indicate that prophylactic treatment with surfactant should be considered in high-risk neonates fulfilling these latter criteria.

Key Words: pulmonary surfactant • respiratory distress syndrome • prevention • infant • premature • glucocorticosteroids

Submitted on December 29, 1992
Accepted on April 1, 1993




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