Reduction of Neonatal Mortality after Multiple Doses of Bovine Surfactant in Low Birth Weight Neonates with Respiratory Distress Syndrome
Author:
Liechty Edward A.,Donovan Edward,Purohit Dilip,Gilhooly Joseph,Feldman Bernard,Noguchi Akihiko,Denson Susan E.,Sehgal Sabitha S.,Gross Ian,Stevens Dennis,Ikegami Machiko,Zachman Richard D.,Carrier Steven T.,Gunkel J. Harry,Gold Alan J.
Abstract
To determine if outcomes of low birth weight neonates with respiratory distress syndrome can be improved by the administration of multiple doses of bovine surfactant, we conducted two identical multicenter, controlled trials, and the results were combined for analysis. Seven hundred and ninety-eight neonates weighing 600 to 1750 g at birth who had developed respiratory distress syndrome within 6 hours of birth were assigned randomly to receive either 100 mg of phospholipid/kg of Survanta, a modified bovine surfactant (n = 402), or a sham dosing procedure (n = 396). Neonates whose respiratory distress persisted could be given up to three more doses, with all doses to be given in the first 48 hours after birth. Dosing was performed by investigators not involved in the clinical care of the neonates; nursery staff were kept blinded as to the treatment assignment. Fewer Survanta-treated neonates died of any cause (18.4% vs 27.3%, P = .002), died of respiratory distress syndrome (9.0% vs 20.3%, P < .001), and either died or developed bronchopulmonary dysplasia due to respiratory distress syndrome (51.2% vs 64.6%, P < .001). Neonates who received Survanta also had greater improvement in their oxygenation and ventilatory status from baseline to 72 hours than did control neonates. Survanta-treated neonates were at lowered risk for developing pulmonary interstitial emphysema (18.6% vs 39.3%, P < .001) and other pulmonary air leaks (11.5% vs 25.9%, P < .001). We conclude that multiple doses of Survanta given after diagnosis of respiratory distress syndrome reduce mortality and morbidity.
Publisher
American Academy of Pediatrics (AAP)
Subject
Pediatrics, Perinatology and Child Health
Cited by
17 articles.
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