Association of Adherence to Surfactant Best Practice Uses With Clinical Outcomes Among Neonates in Sweden

Abstract

Key Points Question What strategies for surfactant treatment of newborn infants are used, and how are these strategies associated with outcomes? Findings In this cohort study of 5209 infants who received 7980 surfactant administrations, late surfactant treatment (>2 hours after birth) was provided for 39% of very preterm infants and associated with higher neonatal morbidity. Off-label use occurred in 19% of infants without any association to outcome, and treatment omissions were associated with lower survival. Meaning In this study, adherence to best practices for surfactant use in newborn infants varied, with important clinical implications for neonatal outcomes.

Surfactant Therapy for Respiratory Distress Syndrome in High- and Ultra-High-Altitude Settings

“…However, in high-altitude regions, fetuses at 35 weeks of gestation may not have reached this peak period; thus, they may have less lung surfactant. SRT administration time and dosage also have an impact on its therapeutic effect in infants with RDS (25,26). It is believed that early administration after RDS diagnosis is more conducive to reducing the mortality.…”

Oxygen for the delivery room respiratory support of moderate‐to‐late preterm infants. An international survey of clinical practice from 21 countries

“…Respondents acknowledged that death was a rare outcome in this population, suggesting instead, to assess cognitive delay as an outcome, which is an important and pervasive cause of disability in this very large infant population 40 . Due to the very large numbers of infants, agile and adaptive trial designs using outcomes embedded within administrative registries will reduce costs and loss to follow‐up 41 . Without further data, our current use of oxygen for resuscitation may continue to cause inadvertent harm to millions of infants around the world every year.…”

Respiratory support of infants born at 22–24 weeks of gestational age

“…Unfortunately, the number of infants born at 22-24 weeks of GA that have been included in previous studies are again, low and the effectiveness of surfactant treatment in this group of patients is less welldocumented. In infants born at 22-24 weeks of GA and admitted for neonatal intensive care, the majority (92%) were treated with surfactant [40]. Most were treated within 2 h of birth and early treatment was associated with significantly lower risks for pneumothorax, intraventricular hemorrhage grades 3-4 and use of postnatal corticosteroids [40].…”

“…In infants born at 22-24 weeks of GA and admitted for neonatal intensive care, the majority (92%) were treated with surfactant [40]. Most were treated within 2 h of birth and early treatment was associated with significantly lower risks for pneumothorax, intraventricular hemorrhage grades 3-4 and use of postnatal corticosteroids [40].…”

“…41 Three administrations (total dose of 300-400 mg/kg) would be sufficient to substitute surfactant deficiency until the endogenous production begins [32]. Use of four or more surfactant administrations has not been associated with improved outcome [40].…”