The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

IS IT MORE ADVANTAGEOUS TO ADMINISTER SURFACTANT TO PREMATURE INFANTS IN THE DELIVERY ROOM OR WAIT UNTIL ADMISSION TO THE NICU?

Khin-Kyemon Aung1,2, Daniel W. Sutton1,2, Susan M. Brant1,2, Firas Saker1,2, Robert L. Chatburn2, John Dickson1,2; 1Hillcrest Hospital, Mayfield Heights, OH; 2Cleveland Clinic, Cleveland, OH

BACKGROUND: Surfactant administration has been proven to significantly reduce mortality, chronic lung disease, bronchopulmonary dysplasia, and duration of mechanical ventilation in very low birth weight infants with respiratory distress syndrome (RDS). Early surfactant replacement therapy has been shown to improve patient outcome, however optimal timing of the first dosage is unclear. Due to inconsistent evidence, administration of surfactant in the delivery room is now becoming commonplace as an alternative to administration in the NICU after stabilization. Since extended time on a ventilator can result in lung injury, it is imperative to determine methods to minimize duration of ventilation. Few data are available comparing surfactant administration in the delivery room to outcome. The purpose of this study was to determine if there is a difference in duration of ventilation between very early and early surfactant administration. METHODS: Data from 2004-2009 for premature neonates were collected from the Vermont-Oxford, Hillcrest Hospital and Cleveland Clinic database. Records of 212 neonates were reviewed with 66 meeting the criteria (RDS, mechanical ventilation only, surfactant administration); 23 were excluded due to death, transfer outside of the Cleveland Clinic Health System, or incomplete records. Very early surfactant administration (SA) was defined as surfactant delay £45 min and early SA was administration >45 min. Duration of ventilation (DV) was defined as the time (min) from intubation to extubation. Linear correlation and a paired t-test were used to evaluate the association between SA and DV; p-values £0.05 were considered significant. RESULTS: Gestational age ranged from 24-34 weeks. SA ranged from 19-207 min and DV ranged from 205-69,161 min. The figure shows the relationship between SA and DV. The low r value indicates no correlation. A subset of the data (gestational age 29-31 weeks, n=23) was also analyzed with similar correlation. CONCLUSION: In this group of patients, results suggest that primary outcome of very early SA does not differ with results of early SA. From this data we can extrapolate that there is no apparent harm in administering surfactant to the neonate after stabilization and suctioning in the NICU rather than in the delivery room immediately after birth. Further randomized, controlled trials are recommended to confirm these benchmark results. Sponsored Research - None