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ARTICLE: Egbert Herting, Olaf Gefeller, Matthias Land, Loekie van Sonderen, Karsten Harms, Bengt Robertson, and Members of the Collaborative European Multicenter Study Group Surfactant Treatment of Neonates With Respiratory Failure and Group B Streptococcal Infection Pediatrics 2000; 106: 957-964 [Abstract] [Full text] [PDF]

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GBS randomization

Renato S Procianoy   (7 November 2000)

Answer to Dr Procianoy

Egbert Herting   (25 November 2000)

GBS randomization 7 November 2000
Renato S Procianoy, neonatologist UFRGS/HCPA - Brazil Send letter to journal: Re: GBS randomization renatosp{at}zaz.com.br Renato S Procianoy	To better analyze the real effect of surfactant therapy on GBS pneumonia of the newborn wasn't better to use a non-treated GBS pneumonia group as a control ? The way the study was done , comparing two diffrent kinds of neonatal diseases , it became very hard to have an idea of the real benefit of surfactant therapy in neonatal GBS pulmonary infection .
Answer to Dr Procianoy 25 November 2000
Egbert Herting, Neonatologist Department of Pediatrics, University of Göttingen, Germany Send letter to journal: Re: Answer to Dr Procianoy eherting{at}med.uni-goettingen.de Egbert Herting	Dear Dr Procianoy, thank you for your question concerning our article on surfactant treatment of infants with severe respiratory failure and GBS infection. Of course, a randomized controlled trial (RCT) would be the only possibility to answer your question. However, as stated in the article and also in the commentary of Prof. Alan Jobe (same volume pp. 1135) "It is not possible to reliably distinguish preterm infants with GBS sepsis/pneumonia from infants with RDS within minutes to hours from birth-the time frame that is optimal for surfactant treatment". As we know that surfactant improves the prognosis of premature infants with RDS, a non-treated control group is no longer possible. For the subgroup of term infants a RCT might be possible, but in Europe or the US such a study would take years as the incidence of severe GBS infection has significantly decreased following the implementation of GBS screening/prophylaxis (see Schrag et al. N Engl J Med 2000;342:15-20). I am afraid the study is not perfect, but it might be the best that we can get at the moment. Sincerely yours Egbert Herting, MD, Ph.D.

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