Surfactant replacement therapy in management of respiratory distress syndrome in preterm infants

الملخص EN

Objectives: This study aimed to compare the différent modes of surfactant replacement therapy (as prophylaxis or rescue treatment) in management of preterm infants with Respiratory Distress Syndrome with ventilation without surfactant.

Method: The study included 90 neonates admitted to NICU at Assiut University Children Hospital diagnosed as RDS according to Gomella et al, 2009, during the period from March 2010 to May 2014.

Patients were classified into 3 groups; group I included 30 preterm babies where surfactant was given endotracheal as a prophylaxis in the Ist 30 minutes after birth followed by extubation to nasal continuous positive airway pressure CPAP (InSurE strategy) in preterm babies <1300 gm weight or <32 wks gestation before the manifestations of RDS were clinically apparent.

Group II: included another 30 preterm babies 28-32 weeks gestation and surfactant was given as a rescue therapy (after diagnosis of RDS clinically and radiologically) either early (within 2 hours postnatal âge) or late (after 2 hours postnatal age).The third group included 30 preterm babies (28-32 weeks gestation), managed by conventional method for management of RDS by mechanical ventilation without surfactant.

Ail groups were compared regarding: clinical assessment (Down's score), puise oxymeter, capillary blood gases, chest x-ray and ventilation parameters, within one hour after birth and 6 hrs after treatment.

Follow up were done to ail patients regarding the duration of respiratory assistance, duration of hospital stay, complications and mortality.

Results: There is a highly significant différence between the three groups (prophylaxis, rescue and group treated by ventilation without surfactant) in the need of respiratory assistance in days (1.27 ± 1.09 vs.

2.18 ± 2.15 vs.

3.46 ± 2.8, respectively), p<0.001, duration of hospital stay in days (22.17 ± 13.3 vs.

12.77 ± 9.6 vs.

7.6 ± 7.2, respectively), p<0.001.

There was a highly significant différence between rescue and ventilated group in death rate (18 (60.0%) vs.

29 (96.7%), respectively), p <0.001.

There was a clinical différence (although statistically insignificant) between prophylaxis and rescue ( 10 (33,3%) vs.

18 (60%)).

There was no statistical significance between the 3 groups in relation to the complications (19 (63.3%) vs.

21 (70%) vs.

21 (70%) respectively).

Conclusion; Prophylactic therapy was better than rescue therapy in determining the outcome and the duration of respiratory assistance with less complication even though the duration of hospital stay was longer.

The death rate among studied cases was higher among rescue and conventional therapy than prophylactic surfactant group.