Can surfactants affect mortality and morbidity in term infants with respiratory failure?

Abstract

Background/aim We aimed to discuss term infants who are given surfactant due to respiratory disorder according to the underlying etiology, the dose of surfactant administration, and the need for repeated surfactant administration. Materials and methods In this retrospective study infants hospitalized in the 4th level neonatal intensive care unit during January 2019 and December 2021 and administered surfactant due to respiratory distress were included. Term infants given surfactant due to respiratory failure were included in the study through the data recording system. The number of surfactant doses, indications for administration, mortality, duration of hospitalization, intubation time, and inotrope use were recorded in the infants included in the study. Results During the two-year period, 1250 infants were hospitalized in our neonatal intensive care unit. Of those, 56 infants received surfactant replacement therapy for severe respiratory failure. There were 30 infants with pneumonia, 4 infants with meconium aspiration syndrome (MAS), and 22 infants with transient tachypnea of the newborn (TTN). It was seen that single-dose administration was higher in patients with TTN (p = 0.01), while multiple-dose surfactant administration was more common in patients with MAS, resulting in a statistical difference (p = 0.02). Mortality was lower, especially in cases given early surfactant administration and this situation was statistically significant (p < 0.001). Duration of intubation was 5.05 ± 4.7 days in early surfactant administration group and 8.0 ± 6.1 days in late surfactant administration group. This difference was statistically significant (p = 0.04). While early surfactant application was statistically higher in the TTN group (p = 0.007), late surfactant application was statistically higher in the pneumonia group (p = 0.001). Conclusion Despite the difference on administration time and repeat dose interval due to etiology, surfactant treatment is improving the respiratory distress of term infants.

Usage of Surfactant and Evaluation of Lung Problems in Late Preterm Infants

“…Kitsommart et al conducted a study in Canada and reported that TTN had a frequency of 47% and RDS with a frequency of 37.3% among respiratory problems in late preterms (23). In the present study investigating the indications for surfactant administration in term infants administered surfactant because of respiratory failure, it was found that from 56 term infants who were administered surfactant, 30 term infants were administered surfactant with the diagnosis of congenital pneumonia and 22 term infants were administered surfactant with the diagnosis of TTN (24). Our recent study showed that surfactant treatment administered in the early period significantly reduces mortality in term infants with severe respiratory failure because of secondary surfactant deficiency caused by TTN and pneumonia (24).…”

“…In the present study investigating the indications for surfactant administration in term infants administered surfactant because of respiratory failure, it was found that from 56 term infants who were administered surfactant, 30 term infants were administered surfactant with the diagnosis of congenital pneumonia and 22 term infants were administered surfactant with the diagnosis of TTN (24). Our recent study showed that surfactant treatment administered in the early period significantly reduces mortality in term infants with severe respiratory failure because of secondary surfactant deficiency caused by TTN and pneumonia (24). In the present study, when the diagnoses of the infants included in the study were examined, it was found that 74 (35.1%) cases were diagnosed with TTN, 120 cases (56.9%) with the diagnosis of RDS, and 17 cases (8.1%) with the diagnosis of pneumonia in the NICU.…”

The current clinical landscape of neonatal respiratory failure in Jiangsu Province of China: patient demographics, NICU treatment interventions, and patient outcomes

“…Surfactant therapy was employed in 38.5% of our patients, of whom 61.9% and 32.6% had RDS and MAS, respectively. While the role of surfactant therapy in RDS is well-established [ 34 , 38 ], its use for the treatment of MAS has only recently gained clinical attention. Our findings corroborated with this, and demonstrated a considerably increased use of surfactant therapy for MAS compared to the previous data (1.8%) [ 2 ].…”