Respiratory distress syndrome in preterm infants of less than 32 weeks: What difference does giving 100 or 200 mg/kg of exogenous surfactant make?

Abstract

Background: Surfactant dosing and effective delivery could affect continuous positive airways pressure (CPAP)-failure. Nevertheless, information on exogenous surfactant dosing with current administration methods is limited.Objective: To describe the effect of 100 or 200 mg/kg of surfactant as first-line treatment of respiratory distress syndrome in preterm infants of less than 32 weeks gestation.Study Design: A retrospective single-center cohort study comparing two epochs, before and after switching from 100 to 200 mg/kg surfactant therapy.Results: Six hundred and fifty-eight of the 1615 infants of less than 32 weeks were treated with surfactant: 282 received 100 mg/kg (S-100) and 376 received 200 mg/ kg (S-200). There were no differences between S-100 and S-200 in perinatal data including prenatal corticosteroids, medication use, age at first surfactant administration and respiratory severity before surfactant.The S-200 vs. S-100 had fewer retreatments (17.0% vs. 47.2%, p < 0.001) and a shorter duration of oxygen therapy and mechanical ventilation (315 vs. 339 h, p = 0.018; 37 vs. 118 h, p = 0.000, respectively). There was no difference in postnatal corticosteroid use (S-200 10.0% vs. S-100 11.0%, p = 0.361). Bronchopulmonary dysplasia (BPD) was significantly lower in S-200 vs. S-100 when comparing either the 4 and 6-year periods before and after the dose switch (29.4% vs. 15.7%, p = 0.003, and 18.7% vs. 27.3%, p = 0.024, respectively) Conclusions: The switch from 100 to 200 mg/kg was associated with a marked reduction in the need for surfactant redosing, respiratory support, and BPD. This

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

“…Many infants can continue on NIV even when surfactant is required. If poractant alfa is used, need for re-dosing can be minimised by using a larger initial dose of 200 mg/ kg [92]. For other surfactants, such data are not available.…”

Use of budesonide associated with a pulmonary surfactant to prevent bronchopulmonary dysplasia in premature newborns – A systematic review

“…Still, regarding the dose of surfactant, a recent retrospective study conducted in Italy 19 showed that a higher initial dose of surfactant (200 mg/kg) had an advantage over the lower dose (100 mg/kg), with a lower incidence of BPD or duration of mechanical ventilation. 19 …”

Reduced pulmonary oxygen diffusion at 36 weeks of postmenstrual age in small‐for‐gestational‐age preterm infants of less than 32 weeks without bronchopulmonary dysplasia

“…Intakes were collected daily, with complete records of amount and type of parenteral nutrition (PN) and enteral nutrition (EN). The detailed neonatal intensive care unit (NICU) nutrition protocol and criteria for surfactant administration have already been published 24,28 . Complications of prematurity were defined according to the Vermont Oxford definitions.…”

“…The detailed neonatal intensive care unit (NICU) nutrition protocol and criteria for surfactant administration have already been published. 24,28 Complications of prematurity were defined according to the Vermont Oxford definitions. SGA was defined as having a BW below the 10th centile, whereas AGA as a BW between the 10th and 90th centile according to the Italian growth charts.…”