ABSTRACT. Objective. To determine whether early versus late treatment with porcine surfactant (Curosurf) reduces the requirement of mechanical ventilation in very preterm infants primarily supported by nasal continuous positive airway pressure (nasal CPAP).Design. Multicenter randomized, controlled trial.Patients. The study population comprised 60 infants <30 weeks' gestation with respiratory distress syndrome (RDS) who had an arterial to alveolar oxygen tension ratio (a/APO 2 ) of 0.35 to 0.22.The cohort from which the study population was generated comprised 397 infants.Results. The need for mechanical ventilation or death within 7 days of age was reduced from 63% in the latetreated infants to 21% in early-treated infants. Increasing numbers of antenatal steroid doses also improved the outcome, especially in the early-treated infants. Six hours after randomization mean a/APO 2 rose to 0.48 in the earlytreated infants compared with 0.36 in the late-treated. The need of mechanical ventilation before discharge was reduced from 68% in the late-treated to 25% in the earlytreated infants.Conclusions. Nasal CPAP in combination with early treatment with Curosurf significantly improves oxygenation and reduces the subsequent need for mechanical ventilation in infants <30 weeks' gestational age with RDS. Pediatrics 1999;103(2). URL: http://www.pediatrics. org/cgi/content/full/103/2/e24; respiratory distress syndrome, pulmonary surfactant, Curosurf, nasal continuous positive airway pressure.ABBREVIATIONS. RDS, respiratory distress syndrome; nasal CPAP, nasal continuous positive airway pressure; a/APo 2 , arterial to alveolar oxygen tension ratio; Fio 2 , fraction of inspired oxygen; TcPo 2 , transcutaneous partial pressure of oxygen; TcPco 2 , transcutaneous partial pressure of carbon dioxide; PDA, patent ductus arteriosus; NEC, necrotizing enterocolitis; BPD, bronchopulmonary dysplasia; IVH, intraventricular hemorrhage; PVL, periventricular leucomalacia; ROP, retinopathy of prematurity. I n a randomized, controlled study we have shown that a single dose of surfactant (Curosurf, Chiesi Farmateutici, Parma, Italy) given by short-lasting intubation reduces the need for mechanical ventilation and improves oxygenation in infants with moderate to severe respiratory distress syndrome (RDS) treated with early nasal continuous positive airway pressure (nasal CPAP).1 Very few pulmonary and extrapulmonary complications were observed in these infants. However, some of the surfactanttreated infants supported by nasal CPAP developed apnea despite good oxygenation and needed mechanical ventilation for that reason. In the same trial, there seemed to be a higher need for ventilation among infants randomized relatively late after birth and in infants with relatively low birth weight. From the literature we know that surfactant given prophylactically, 2-4 or as early treatment to infants requiring mechanical ventilation, 5 is more effective than late rescue treatment.The present study was designed to test the hypothesis that infants Ͻ30 we...

In babies with moderate-to-severe respiratory distress syndrome treated with nasal continuous positive airway pressure, a single dose of surfactant reduced the need for subsequent mechanical ventilation.

Prophylactic surfactant was not superior to nCPAP and early selective surfactant in decreasing the need for MV in the first 5 days of life and the incidence of main morbidities of prematurity in spontaneously breathing very preterm infants on nCPAP.

Aim: To determine the incidence amongst infants born at term or near‐term of extreme hyperbilirubinaemia, i.e., with a serum concentration of unconjugated bilirubin exceeding the limit above which an exchange transfusion was indicated according to the authorized guidelines. Method: The investigation period covered 2 y, 1 January 2000 to 31 December 2001, and included all infants born alive at term or near‐term in Denmark. All infants with extreme hyperbilirubinaemia admitted to paediatric departments were recorded. Results: Thirty‐two infants developed extreme hyperbilirubinaemia, i.e., an incidence of 25 per 100 000. The maximum total serum bilirubin concentration (TSB) was 492 (385–689) μmol/l (median (range)). The median value of the exchange transfusion limits was 450 μmol/l. Twelve infants had signs and symptoms of central nervous system involvement; 11 had acute bilirubin encephalopathy phase‐1 symptoms; and one had phase‐2 symptoms. Nineteen infants developed extreme hyperbilirubinaemia during primary admission to the maternity ward or neonatal department; the others after having been discharged. There was no difference in maximum TSB between those infants not discharged from hospital and those infants admitted to hospital from home. Maximum TSB appeared latest amongst those infants admitted from home (p<0.01), and these more often had signs and symptoms of central nervous system involvement (p<0.05). Ten infants were of non‐Caucasian extraction. Less than half of all Danish mothers receive both verbal and written information after birth on jaundice in the infant. Conclusion: Twenty‐five per 100 000 infants born at term or near‐term developed extreme hyperbilirubinaemia, the majority of them whilst in hospital. Infants admitted from home more often had signs and symptoms of central system involvement.

The Scandinavian approach is an effective combined treatment for respiratory distress syndrome (RDS) and prevention of bronchopulmonary dysplasia (BPD). It is composed of many individual parts.Of significant importance is the early treatment with nasal continuous positive airway pressure (nCPAP) and surfactant treatment. The approach may be supplemented with caffeine citrate and non-invasive positive pressure ventilation for apnoea. The low incidence of BPD seen as a consequence of the treatment strategy is mainly due to a reduced need for mechanical ventilation (MV).Conclusion: Early-postnatal treatment with nCPAP and surfactant decreases the severity and mortality of RDS and BPD. This is mainly due to a diminished use of MV in the first days of life.

Twenty-five per 100 000 infants born at term or near-term developed extreme hyperbilirubinaemia, the majority of them whilst in hospital. Infants admitted from home more often had signs and symptoms of central system involvement.

Prenatal steroids, early nasal CPAP combined with early surfactant treatment followed by extubation to nasal CPAP, and if necessary mechanical ventilation is a very effective treatment of respiratory distress syndrome. This treatment package is part of the 'Scandinavian model' for treatment of very-low-birthweight infants which also comprises gentle ventilation at birth; minimal handling; 'neonatal individualized development care and assessment program'; high priority of breast feeding; and use of kangaroo method and which facilitates observation and nursing of sick premature infants and optimizes the possibility for early mother-child contact. The incidence of bronchopulmonary dysplasia seems to be less of a problem in centres preferring nasal CPAP as the primary treatment for respiratory distress syndrome.

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