Bovine Surfactant Replacement Therapy in Neonates of Less than 32 Weeks' Gestation: A Multicenter Controlled Trial of Prophylaxis versus Early Treatment in China — a Pilot Study

Background A domestic surfactant preparation has been used in China for a number of years. However, as for other surfactant preparations, there is debate among neonatologists regarding the optimal dose, mode of administration, and the best time of intervention. Objective To evaluate whether prophylactic administration of surfactant is superior to early treatment in preterm infants Methods We prospectively compared small premature infants ( N  = 116) with infants who received surfactant therapy for established RDS (early treatment group, N  = 91). The primary outcome assessed was the incidence of RDS. The secondary outcomes assessed were severity of RDS, mortality, and bronchopulmonary dysplasia morbidity. Results Compared with the early treatment group, the prophylactic group had a significantly better PaO 2 (at 1 hour, 4 hours, and 12 hours postdose, respectively), better a/APO 2 (at 1 hour, 4 hours, 12 hours, and 24 hours postdose, respectively), lower PaCO 2 (at 1 hour postdose), and a significantly decreased need for mean airway pressure (MAP) and FiO 2 on ventilation ( p p p p p Conclusion In preterm infants under 32 weeks' gestation, prophylactic use of a domestic surfactant preparation is better than early surfactant treatment in improving pulmonary status and in decreasing the incidence of severe RDS and duration on mechanical ventilation.