Early Routine versus Late Selective Surfactant in Preterm Neonates with Respiratory Distress Syndrome on Nasal Continuous Positive Airway Pressure: A Randomized Controlled Trial

Background: Preterm neonates with respiratory distress syndrome (RDS) benefit from early application of nasal continuous positive airway pressure (nCPAP). However, it is not clear whether surfactant should be administered early as a routine to all such infants or later in a selective manner. Objective: It was the aim of this study to compare the efficacy of early routine versus late selective surfactant treatment in reducing the need for mechanical ventilation (MV) during the first week of life among moderate-sized preterm infants with RDS being supported by nCPAP. Methods: Infants born at 28(0/7) to 33(6/7) weeks of gestation with RDS and on nCPAP were randomly assigned within the first 2 h of life to early routine surfactant administration by the InSurE technique (early surfactant group) or to late selective administration of surfactant (late surfactant group). The primary outcome was need for MV in the first 7 days of life. Results: Among 153 infants randomized to early (n = 74) or late surfactant (n = 79) groups, the need for MV was significantly lower in the early surfactant group (16.2 vs. 31.6%; relative risk 0.41, 95% confidence interval 0.19-0.91). The incidence of pneumothorax (1.9 vs. 2.3%) and the need for supplemental O-2 at 28 days (2.7 vs. 8.9%) were similar in the two groups. Conclusion: Early routine surfactant administration within 2 h of life as compared to late selective administration significantly reduced the need for MV in the first week of life among pre-term infants with RDS on nCPAP. Copyright (C) 2012 S. Karger AG, Basel