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Journal Article
When to treat with surfactant?
2023
Overview
Correspondence to Dr David G Sweet, Neonatal Unit, Royal Maternity Hospital, Belfast, Belfast, UK; david.sweet@belfasttrust.hscni.net Synthesis of available data by different expert groups has resulted in differing fraction of inspired oxygen (FiO2) thresholds for surfactant therapy in babies with respiratory distress syndrome (RDS). Branagan et al attempt through network meta-analysis to determine if there is an optimal FiO2 cut-off for surfactant therapy to reduce any of the important negative outcomes of prematurity including mortality and bronchopulmonary dysplasia (BPD). Cochrane meta-analysis of six randomised trials show a reduction in mortality (RR 0.69; 95% CI 0.55 to 0.86) and the combined outcome of death or BPD (RR 0.83; 95% CI 0.75 to 0.91) for the babies treated earlier; however, the included studies randomised infants according to time after birth, rather than by FiO2 thresholds.1 For preterm babies managed on CPAP, Verder and coworkers showed us 20 years ago that surfactant at an earlier time point compared with later would reduce the need for mechanical ventilation or death before 7 days. Lung ultrasound, with appropriate training, may offer an alternative way of diagnosing significant RDS best treated at an earlier stage, without apparently resulting in more infants overall being treated.5 Rapid point-of-care testing for surfactant components in gastric aspirate is also now available, and clinical trials will hopefully determine if these tests can predict who should receive surfactant before the infant becomes very unwell.
Publisher
BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health,BMJ Publishing Group LTD
