2012 OPEN FORUM Abstracts
INITIAL FIO2 REQUIREMENTS FOR PRETERM INFANTS RECEIVING SURFACTANT IN THE DELIVERY ROOM VS. PRETERM INFANTS THAT DID NOT RECEIVE SURFACTANT IN THE DELIVERY ROOM.
Matthew Trojanowski, Shawn Hughes; The Johns Hopkins Hospital, Baltimore, MD
INTRODUCTION: Administration of exogenous surfactant is frequently included in a preterm infants plan of care, but some debate persists regarding whether or not it should be routinely administered in the delivery room (DR). We examined initial FiO2 requirements on conventional mechanical ventilation for preterm infants that received surfactant in the DR vs. those that did not. METHODS: A database with information regarding surfactant delivery at birth (July 2009 Oct 2010) was reviewed. Data for infants intubated at delivery with GA < /=30 weeks was examined (n = 73). 44 patients were excluded for insufficient data (n = 24), or not receiving conventional ventilation post-delivery (n = 20). Infants not excluded (n = 29) were divided into two groups: Those that received surfactant in the DR (n = 16, mean BW = 943.75 kg, mean GA = 26 1/7 weeks), and those that did not (n = 13, mean BW = 1190.5 kg, mean GA = 27 5/6 weeks). The data lacked a normal distribution, so it was analyzed using a Mann-Whitney U test. RESULTS: Infants receiving surfactant in the DR: mean FiO2 = 0.29, median FiO2 = 0.30; Infants not receiving surfactant in the DR: mean FiO2 = 0.41, median FiO2 = 0.35; p = .184. CONCLUSION: Although both mean and median initial FiO2 requirements were lower for the group that received surfactant in the DR, the difference did not reach statistical significance (p = .184). Despite this, there is still value in the finding that the group receiving surfactant in the DR had a lower initial FiO2 requirement. The results, however, need to be interpreted with some caution. A large number of patients from the initial cohort were excluded in order to limit the study population. In addition, SpO2 levels varied widely (80% - 100% SpO2) in each group and indicate that several patients probably required more or less FiO2 than what was being administered. It is important to note that this was a retrospective review of an existing database and, as such, information recorded in the database was limited and subject to documentation error. Despite the study limitations and lack of statistical significance, there was a reduction in mean and median initial FiO2 requirements for the group that received surfactant in the DR. The results of this review are encouraging, but need further validation through larger studies with more stringent control of variables. Sponsored Research - None