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FROM THE AMERICAN ACADEMY OF PEDIATRICS:
William A. Engle and the Committee on Fetus and Newborn
Surfactant-Replacement Therapy for Respiratory Distress in the Preterm and Term Neonate
Pediatrics 2008; 121: 419-432 [Abstract] [Full text] [PDF]
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[Read P3R] Surfactant Prophylaxis in the Small but Stable Premature
Steve Piecuch, MD, MPH   (15 February 2008)

Surfactant Prophylaxis in the Small but Stable Premature 15 February 2008
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Steve Piecuch, MD, MPH,
Neonatologist
Kings County Hospital Center, Brooklyn, New York

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Re: Surfactant Prophylaxis in the Small but Stable Premature

stevepiecuch{at}aol.com Steve Piecuch, MD, MPH

The report of the Committee on Fetus and Newborn published in the February 2008 issue of Pediatrics makes the point that infants < 30 weeks gestation who receive prophylactic surfactant do better than those who receive rescue surfactant. Some NICU's individualize their approach to such infants, giving those who appear to be doing well a trial of nasal CPAP without intubation and without surfactant replacement. In the absence of evidence that the benefit of surfactant outweighs the risk of intubation and positive pressure ventilation in the infant < 30 weeks gestation who does not require intubation because of respiratory distress, such an approach seems reasonable, especially if the mother received an adequate course of antenatal steroids. I think that it would be a mistake for neonatologists to conclude that all infants < 30 weeks gestation should be intubated and given prophylactic surfactant, or that the evidence supports such an approach. It is quite possible that, in the subgroup described above, such an approach might actually be associated with a less favorable outcome. I believe that the Committee's statement recognizes the relative lack of good evidence in this area.

Conflict of Interest:

None declared