Abstract
Objective Timely and effective noninvasive respiratory support and surfactant administration
are the key determinants of clinical outcomes in very preterm infants. The objective
of this study was to evaluate the impact of the changes in clinical practice of surfactant
administration on clinical outcomes and the incidence of continuous positive airway
pressure (CPAP) failure defined as the need for mechanical ventilation (MV) during
the first 5 days of life in preterm infants <32 weeks.
Study Design One hundred sixty-five outborn very preterm infants with respiratory distress syndrome
(RDS), initially managed on CPAP, were enrolled in a retrospective cohort study. Fifty-two
infants treated with surfactant using less invasive or INSURE technique were included
in the surfactant group. One hundred thirteen control infants received surfactant
only in case of CPAP failure.
Results The study groups were similar in gestational age, rates of main obstetric complications,
and antenatal steroid prophylaxis. The rate of cesarean delivery was significantly
higher but birth weight and need for resuscitation were lower in infants from the
surfactant group. Fifty-five infants with CPAP failure (49%) received surfactant after
initiation of MV in the control group in comparison with 52 (100%) in the surfactant
group (p < 0.001). The incidence of CPAP failure was significantly higher in the control group
(49 vs. 27%; p < 0.01) and it occurred earlier (median [interquartile range age: 4 [2–5] vs. 47
[36–99] hours, respectively; p < 0.001). Early surfactant administration significantly and independently affected
the probability of CPAP failure (adjusted odds ratio: 0.29, 95% confidence interval:
0.13–0.67; p < 0.01). There were no differences in morbidities between the groups, but CPAP failure
was significantly associated with higher morbidity and mortality.
Conclusion Adherence to the European RDS guidelines with early rescue, less invasive surfactant
administration in very preterm infants decreased the probability of CPAP failure which
was significantly associated with higher morbidity and mortality.
Key Points
-
Early surfactant decreases the probability of CPAP failure.
-
Timing and methods of surfactant administration are important.
-
Randomized comparisons of prophylactic LISA and CPAP are needed.
Keywords
respiratory care - CPAP failure - surfactant therapy - clinical outcomes - infant
