Bovine Surfactant Replacement Therapy in Neonates of Less than 32 Weeks' Gestation: A Multicenter Controlled Trial of Prophylaxis versus Early Treatment in China — a Pilot Study
A domestic surfactant preparation has been used in China for a number of years. However, as for other surfactant preparations, there is debate among neonatologists regarding the optimal dose, mode of administration, and the best time of intervention. Objective: To evaluate whether prophylactic admin...
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doaj-ff0c3866b87047b0b713c333646d54732020-11-24T20:54:26ZengElsevierPediatrics and Neonatology1875-95722016-02-01571192610.1016/j.pedneo.2015.03.007Bovine Surfactant Replacement Therapy in Neonates of Less than 32 Weeks' Gestation: A Multicenter Controlled Trial of Prophylaxis versus Early Treatment in China — a Pilot StudyXiangyong Kong0Qiliang Cui1Yuhua Hu2Weimin Huang3Rong Ju4Wen Li5Ruijuan Wang6Shiwen Xia7Jialin Yu8Tian Zhu9Zhichun Feng10Newborn Care Center, Bayi Children's Hospital, the Military General Hospital of Beijing P.L.A., Beijing, ChinaDepartment of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, ChinaDepartment of Pediatrics, Jiangsu Province Hospital, Nanjing, ChinaDepartment of Pediatrics, Nanfang Hospital, Nanfang Medical University, Guangzhou, ChinaNewborn Care Center, Chengdu Women's and Children's Central Hospital, Chengdu, ChinaDepartment of Pediatrics, Qilu Hospital of Shandong University, Jinan, ChinaNewborn Care Center, Bayi Children's Hospital, the Military General Hospital of Beijing P.L.A., Beijing, ChinaDepartment of Pediatrics, Hospital of Hubei Province, Wuhan, ChinaDepartment of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, ChinaDepartment of Neonatology, Daping Hospital, The Third Military Medical University, Chongqing, ChinaNewborn Care Center, Bayi Children's Hospital, the Military General Hospital of Beijing P.L.A., Beijing, ChinaA domestic surfactant preparation has been used in China for a number of years. However, as for other surfactant preparations, there is debate among neonatologists regarding the optimal dose, mode of administration, and the best time of intervention. Objective: To evaluate whether prophylactic administration of surfactant is superior to early treatment in preterm infants < 32 weeks with a high risk of respiratory distress syndrome (RDS). Methods: We prospectively compared small premature infants (< 32 weeks) receiving 70 mg/kg bovine surfactant within 30 minutes after birth (prophylactic group, N = 116) with infants who received surfactant therapy for established RDS (early treatment group, N = 91). The primary outcome assessed was the incidence of RDS. The secondary outcomes assessed were severity of RDS, mortality, and bronchopulmonary dysplasia morbidity. Results: Compared with the early treatment group, the prophylactic group had a significantly better PaO2 (at 1 hour, 4 hours, and 12 hours postdose, respectively), better a/APO2 (at 1 hour, 4 hours, 12 hours, and 24 hours postdose, respectively), lower PaCO2 (at 1 hour postdose), and a significantly decreased need for mean airway pressure (MAP) and FiO2 on ventilation (p < 0.05). The prophylactic group had shorter durations for mechanical ventilation and supplemental oxygen compared with the early treatment group (p < 0.01 and p < 0.05, respectively). The incidence of RDS was comparable between the groups; however, the prophylactic group had a significantly lower incidence of severe RDS and significantly lower rate of repeated doses of surfactant than the early treatment group (p < 0.05). The incidences of bronchopulmonary dysplasia and patent ductus arteriosus were also lower in the prophylactic group than the early treatment group (p < 0.05). The two groups were comparable in mortality rate. Conclusion: In preterm infants under 32 weeks' gestation, prophylactic use of a domestic surfactant preparation is better than early surfactant treatment in improving pulmonary status and in decreasing the incidence of severe RDS and duration on mechanical ventilation.http://www.sciencedirect.com/science/article/pii/S1875957215000613bovine surfactantpremature infantsprophylactic administrationrespiratory distress syndrome |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Xiangyong Kong Qiliang Cui Yuhua Hu Weimin Huang Rong Ju Wen Li Ruijuan Wang Shiwen Xia Jialin Yu Tian Zhu Zhichun Feng |
spellingShingle |
Xiangyong Kong Qiliang Cui Yuhua Hu Weimin Huang Rong Ju Wen Li Ruijuan Wang Shiwen Xia Jialin Yu Tian Zhu Zhichun Feng Bovine Surfactant Replacement Therapy in Neonates of Less than 32 Weeks' Gestation: A Multicenter Controlled Trial of Prophylaxis versus Early Treatment in China — a Pilot Study Pediatrics and Neonatology bovine surfactant premature infants prophylactic administration respiratory distress syndrome |
author_facet |
Xiangyong Kong Qiliang Cui Yuhua Hu Weimin Huang Rong Ju Wen Li Ruijuan Wang Shiwen Xia Jialin Yu Tian Zhu Zhichun Feng |
author_sort |
Xiangyong Kong |
title |
Bovine Surfactant Replacement Therapy in Neonates of Less than 32 Weeks' Gestation: A Multicenter Controlled Trial of Prophylaxis versus Early Treatment in China — a Pilot Study |
title_short |
Bovine Surfactant Replacement Therapy in Neonates of Less than 32 Weeks' Gestation: A Multicenter Controlled Trial of Prophylaxis versus Early Treatment in China — a Pilot Study |
title_full |
Bovine Surfactant Replacement Therapy in Neonates of Less than 32 Weeks' Gestation: A Multicenter Controlled Trial of Prophylaxis versus Early Treatment in China — a Pilot Study |
title_fullStr |
Bovine Surfactant Replacement Therapy in Neonates of Less than 32 Weeks' Gestation: A Multicenter Controlled Trial of Prophylaxis versus Early Treatment in China — a Pilot Study |
title_full_unstemmed |
Bovine Surfactant Replacement Therapy in Neonates of Less than 32 Weeks' Gestation: A Multicenter Controlled Trial of Prophylaxis versus Early Treatment in China — a Pilot Study |
title_sort |
bovine surfactant replacement therapy in neonates of less than 32 weeks' gestation: a multicenter controlled trial of prophylaxis versus early treatment in china — a pilot study |
publisher |
Elsevier |
series |
Pediatrics and Neonatology |
issn |
1875-9572 |
publishDate |
2016-02-01 |
description |
A domestic surfactant preparation has been used in China for a number of years. However, as for other surfactant preparations, there is debate among neonatologists regarding the optimal dose, mode of administration, and the best time of intervention.
Objective: To evaluate whether prophylactic administration of surfactant is superior to early treatment in preterm infants < 32 weeks with a high risk of respiratory distress syndrome (RDS).
Methods: We prospectively compared small premature infants (< 32 weeks) receiving 70 mg/kg bovine surfactant within 30 minutes after birth (prophylactic group, N = 116) with infants who received surfactant therapy for established RDS (early treatment group, N = 91). The primary outcome assessed was the incidence of RDS. The secondary outcomes assessed were severity of RDS, mortality, and bronchopulmonary dysplasia morbidity.
Results: Compared with the early treatment group, the prophylactic group had a significantly better PaO2 (at 1 hour, 4 hours, and 12 hours postdose, respectively), better a/APO2 (at 1 hour, 4 hours, 12 hours, and 24 hours postdose, respectively), lower PaCO2 (at 1 hour postdose), and a significantly decreased need for mean airway pressure (MAP) and FiO2 on ventilation (p < 0.05). The prophylactic group had shorter durations for mechanical ventilation and supplemental oxygen compared with the early treatment group (p < 0.01 and p < 0.05, respectively). The incidence of RDS was comparable between the groups; however, the prophylactic group had a significantly lower incidence of severe RDS and significantly lower rate of repeated doses of surfactant than the early treatment group (p < 0.05). The incidences of bronchopulmonary dysplasia and patent ductus arteriosus were also lower in the prophylactic group than the early treatment group (p < 0.05). The two groups were comparable in mortality rate.
Conclusion: In preterm infants under 32 weeks' gestation, prophylactic use of a domestic surfactant preparation is better than early surfactant treatment in improving pulmonary status and in decreasing the incidence of severe RDS and duration on mechanical ventilation. |
topic |
bovine surfactant premature infants prophylactic administration respiratory distress syndrome |
url |
http://www.sciencedirect.com/science/article/pii/S1875957215000613 |
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