A new method of surfactant administration in preterm infants.

Surfactant treatment substantially improves outcomes for preterm infants with respiratory distress syndrome.1 However, the optimal timing and method of administration of this treatment are less clear.2, 3 and 4 In The Lancet, Wolfgang Göpel and colleagues, 5 on behalf of the German Neonatal Network, report the results of a multicentre randomised controlled trial investigating a new minimally invasive method of early surfactant administration in spontaneously breathing preterm infants who are supported with continuous positive airway pressure. Compared with the intubate, surfactant, and extubate technique, 6 in which surfactant is administered during a short period of positive pressure ventilation, this new intervention could offer an advantage because positive pressure ventilation can be avoided completely. In Göpel and colleagues' trial 220 preterm infants of a gestational age between 26 and 28 weeks and a birthweight less than 1500 g were randomly assigned to receive either early surfactant administration during spontaneous breathing or a standard approach of intubation when judged appropriate, then surfactant administration during mechanical ventilation. In the intervention group, the need for mechanical ventilation on day 2 or 3 after birth, or the risk of being not ventilated but having a partial pressure of carbon dioxide more than 65 mm Hg (8·6 kPa) or a fraction of inspired oxygen of more than 0·60, or both, for more than 2 h between 25 h and 72 h of age, was significantly lower than in the control group, with an absolute risk reduction of 0·18 (95% CI 0·30-0·05) and a number needed to treat of 6 (3-20).

Jaar van publicatie:2011

Trefwoorden:premature infants, exogenous surfactant