Effects of two rescue doses of synthetic surfactant in 344 infants with respiratory distress syndrome weighing 750 to 1249 grams: A double-blind, placebo-controlled multicenter Canadian trial

McMillan, Douglas; Chernick, Víctor; Finer, Neil N.; Schiff, David; Bard, Harry; Watts, John; Krzeski, Robert; Long, Walker

doi:10.1016/s0022-3476(95)70013-7

Cited by 14 publications

(7 citation statements)

References 15 publications

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“…3 Data from more recent prospective randomized placebo-controlled surfactant trials confirmed these observations. [23][24][25] Because our study NICUs used only a rescue strategy for surfactant treatment, our observation that surfactant replacement therapy did not increase the risk of clinically significant PH is consistent with prior studies.…”

Section: Discussionsupporting

confidence: 86%

Antecedents of Clinically Significant Pulmonary Hemorrhage Among Newborn Infants

2000

J Perinatol

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OBJECTIVE:To evaluate risk factor profiles associated with clinically significant pulmonary hemorrhage (PH) in preterm (PT) and term infants. STUDY DESIGN:Case-control study of all infants with PH cared for in three Harvardaffiliated neonatal intensive care units between 1987 and 1994. RESULTS:A total of 50 cases of PH occurred in PT infants (gestational age (GA) of Յ34 weeks), and 26 cases occurred in near-term/full-term (NT/FT) infants (GA of Ͼ34 weeks). The median age at the time of PH was 46 hours among PT infants compared with 6 hours among NT/FT infants. For PT infants, four factors best predicted PH: a GA of between 24 and 26 weeks and antenatal glucocorticoid treatment reduced the risk (odds ratios (ORs) of 0.7 and 0.3, respectively), whereas requirement for resuscitation with positive pressure ventilation and thrombocytopenia were associated with increased risk (ORs of 4.3 and 4.0, respectively). Among the NT/FT infants, the model included three variables: meconium aspiration (OR 4.9), requirement for resuscitation with positive pressure ventilation (OR 2.9), and hypotension (OR 3.5). CONCLUSION:Antecedent factors and timing of PH differ between PT and NT/FT infants, suggesting that the mechanisms contributing to PH are influenced by developmental maturity as well as perinatal and neonatal medical conditions and interventions.

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Section: Discussionsupporting

confidence: 86%

Antecedents of Clinically Significant Pulmonary Hemorrhage Among Newborn Infants

2000

J Perinatol

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“…The metaanalysis of five trials [42][43][44][45][46] shows a significant reduction in neonatal mortality, BPD and BPD or death in infants who received synthetic surfactant treatment for RDS when compared with controls ( fig. 2).…”

Section: Synthetic Surfactant Treatment In Rdsmentioning

confidence: 99%

Bronchopulmonary Dysplasia and Surfactant

Bancalari

Moral²

2001

Neonatology

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Bronchopulmonary dysplasia (BPD) is the most common respiratory complication in preterm infants who survive prolonged mechanical ventilation. Exogenous surfactant administration clearly reduces the severity of respiratory distress syndrome (RDS) and consequently the need for aggressive ventilation and prolonged oxygen therapy. However, the overall incidence of BPD has not decreased but in fact may even have increased after the introduction of surfactant therapy. There are several reasons for the lack of effect on the incidence of BPD. First, surfactant therapy and antenatal steroids have markedly increased survival of the smallest infants, i.e. those at higher risk of BPD. Second, there has been a change in the pathogenesis and the presentation of BPD. While the classic BPD was mainly the consequence of barotrauma and oxygen toxicity, the new BPD seen in the surfactant era results from the interaction of many factors that lead to prolonged mechanical ventilation and colonization of the airway with pathogens that may trigger an inflammatory cascade. While the overall incidence of BPD has not been substantially modified by surfactant therapy, the more severe cases of BPD have become less common. The data regarding the effect of surfactant administration on the incidence and severity of BPD is conflicting. There is substantial evidence that the administration of exogenous surfactant, either as prophylaxis or as a treatment in infants with established RDS, can reduce neonatal mortality and the occurrence of BPD or death. The data also suggest that prophylactic or early administration is more effective than late treatment in reducing mortality and BPD or death. No clear difference has been documented between natural or synthetic surfactant treatment in terms of their effect on incidence of BPD or mortality. The lack of consistency in the results with surfactant replacement may reflect the changing pathogenesis of BPD and the multiplicity of factors involved among which surfactant deficiency is only one.

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“…This presumption is supported with what was concluded by McMillan et al . that two rescue doses of surfactant cause physiologic improvement in premature infants weighing 750−1249 g with RDS, and improve the survival rate without CLD at 28 days of life 24 …”

Section: Discussionmentioning

confidence: 97%