ABSTRACT
The risk-to-benefit ratio of surfactant treatment of outborn preterm infants prior,
as opposed to after, transportation to a perinatal center is not known. The objective
of this study was to document current practice and to examine clinical outcomes in
North America. In phase I (December, 1991 to January, 1992) questionnaires were distributed
to 114 perinatal centers in the United States and Canada. The centers returned 98
surveys. Over half (50.5%) of the centers report giving surfactant rescue prior to
infant transport, but only a minority (9.5%) of the centers report doing so for prophylaxis.
In phase II (January, 1992 to December, 1992), clinical outcomes of surfactant-eligible
babies requiring interhospital transport at a university hospital were evaluated to
determine which infants ultimately received surfactant and when. The infants were
compared between groups and did not differ significantly in gestational age, birthweight,
sex type, number of multiple births, five-minute Apgar scores, or whether antenatal
steroids were used. In phase II, the 66 consecutive, ventilator-dependent, outborn
infants with average, and median, gestational age of 28 weeks were compared. The infants
receiving surfactant prior to transport, when compared to the infants that got it
after transport (9 hours later), did not do any better. There was 6% more survival
without bronchopulmonary dysplasia in the group receiving surfactant after transport
(65.2% versus 59.3%, p=0.665). The infants receiving surfactant after transport were
off the ventilator sooner (95% C.I. 6.0-28.7 versus 11.8-25.9 days) and discharged
from the perinatal center earlier (95% C.I. 37.8-70.8 versus 47.9-69.0 days). Furthermore,
arterial blood gases before and after transport reveals that there were no short-term
advantages in administering surfactant prior to transport when compared to waiting
for reevaluation at the perinatal center. These findings suggest that surfactant can
be used safely prior to the interhospital transport of preterm infants, but this treatment
does not seem to confer benefit over waiting for reevaluation, and possible surfactant
treatment, at the tertiary perinatal center.
Keywords
Surfactant - hyaline membrane disease - bronchopulmonary dysplasia - transport - perinatal
centers - arterial blood gases
