Timing of exogenous surfactant administration in clinical practice. Report of a multi-center Italian Observational Study.

UNLABELLED: We now have convincing data that surfactant administration in newborns with the respiratory distress syndrome (RDS) is effective in reducing the need for respiratory supports and improves the clinical outcomes. To evaluate the different strategies adopted in clinical practice for the surfactant use we performed an observational multicenter study. All newborns with gestational age (g.a.) between 24-32 wk. with RDS and that were in need of mechanical ventilation and treated with exogenous surfactant from 1994 to 1996 in twelve Neonatal Intensive Care Units have been evaluated. The patients have been divided into two groups: one includes babies that were given surfactant within the first 15 minutes of life (very early -VE- treated) and the other includes those that received the treatment at age 16- 180 minutes (early -E- treated). The analysis concerned 246 cases, 54 VE treated and 192 E treated. The two groups were comparable with regards to sex, Apgar score at one and five minutes, maternal treatment with steroids and multiple pregnancy. Mean birth weight and g.a. were significantly lower and the rate of caesarean sections was higher in the VE than in the E. Almost 80% of the VE newborns had a g.a. equal or less than 28 wks. One single dose of surfactant was administered in 77.8% of VE babies and 45.3% in the E group, while 18.5% VE and 36.8% E received two doses, 3.7% VE and 16.3% E were given three doses. The mean number of doses used per patient was 1.3 in VE and 1.7 in E. 62.5% of cases with g.a. equal to or less than 26 wks and 80.8% of those with g.a. 27-28 wk. received a single dose if VE, compared to 31.9% and 49.1% respectively if E treated. Prenatal prophylaxis of RDS with steroids, considering only the mothers that received a complete course between 48 hrs and 7 days before the delivery, did not modify the number of doses of surfactant required in both groups. The main outcomes did not differ in the two groups: mortality at 28 days of life, age at death, pneumothorax, intraventricular haemorrhage grade 3-4, retinopathy of prematurity grade 3-4, patent ductus arteriosus and oxygen dependency at 36 wks post-conceptional age. CONCLUSIONS: Very early surfactant administration in clinical practice reserved for newborns with the lowest g.a., improves the outcome and does not increase surfactant consumption.