In a neonatal unit which, at that time, had no facilities for artificial ventilation, 14 newborn infants with birth weight ≥ 1,500 g fulfilling the diagnostic criteria for severe hyaline membrane disease (HMD) were treated by tracheal instillation of bovine surfactant (200 mg/kg). Twelve of these babies showed increased transcutaneous PO₂/FiO₂ ratio within 2 min, the average therapeutic response being sustained for at least 72 h. One of the two babies who did not respond to treatment was later diagnosed as a case of group B streptococcal pneumonia. One baby with favorable initial response died from sepsis at the age of 7 days; the other patients survived without sequelae. We conclude that treatment with exogenous surfactant might be considered as an alternative to ventilator treatment in babies with severe HMD.

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