Surfactant Treatment in Late Preterm and Term Newborns; Indications and Outcomes

Objective: Surfactant therapy (ST) has significantly reduced mortality and respiratory morbidities among preterm infants with respiratory distress syndrome (RDS). However, majority of late preterm and term infants with respiratory distress also suffer from non-RDS lung diseases. In some of these diseases, secondary surfactant deficiency may develop and ST can be beneficial. In this study we evaluated the indications and early outcomes of ST in late preterm and term infants. Material and Methods: We retrospectively evaluated the medical records of 135 late preterm and term infants who underwent ST between January 2009 and December 2012. The clinical characteristics of the patients, their diagnoses, number of surfactant application and time of administration, FiO2 requirements before and after ST (1st and 6th hours),duration of mechanical ventilation, and mortality rate were evaluated. Results: Among135 late preterm and term patients treated with ST, 78 (57.8%) were given ST due to lung disease other than RDS and had longer mechanical ventilator duration. In addition, ≥ 2 doses of surfactant requirement, pulmonary hypertension and mortality rate were found to be higher in these infants. Among patients with RDS, as expected, FiO2 requirement was found to decrease in the 1st and 6th hours after ST (0.60 to 0.50 & 0.37 and p <0.001). Sixteen percent of newborns with congenital pneumonia required repeated surfactant doses. The FiO2 requirement after ST was decreased in 42 patients with congenital pneumonia (0.67 to 0.65 & 0.48 and p <0.001). Sixteen patients with severe meconium aspiration syndrome (median FiO2; 0.98) and 25 patients supporting with high frequency oscillatory ventilation (HFOV) support did not benefit from ST (p = 0.71 and p = 0.964). Conclusion: We observed that ST reduced oxygen requirement in the late preterm and term infants with RDS and congenital pneumonia. However, we found that ST was not beneficial in the infants who applied HFOV due to severe respiratory insufficiency. We think that prospective studies involving a larger number of patients are needed to determine treatment options in these patient groups