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Background: Nasal continuous positive airway pressure (nCPAP) is the standard noninvasive respiratory support for newborns with respiratory distress. Evidence for high-flow nasal cannula (HFNC) as an alternative mode of respiratory support is inconclusive. Objective: The aim of this work was to evaluate whether HFNC is not inferior to nCPAP in reducing the need for higher respiratory support in the first 72 h of life when applied as a noninvasive respiratory support mode for preterm neonates with respiratory distress. Methods: Preterm infants (gestation ≥28 weeks and birth weight ≥1,000 g) with respiratory distress were randomized to either HFNC or nCPAP in a non-inferiority trial. Failure of the support mode in the first 72 h after birth was the primary outcome. Infants failing HFNC were rescued either with nCPAP or mechanical ventilation, and those failing nCPAP received mechanical ventilation. Results: During the study period, 139 and 133 infants were randomized to the nCPAP and HFNC groups, respectively. The study was stopped after an interim analysis showed a significant difference (p < 0.001) in the primary outcome between the 2 groups. The treatment failure was significantly higher in the HFNC group (HFNC, n = 35, 26.3%, vs. CPAP, n = 11, 7.9%, risk difference 18.4 percentage points, 95% CI 9.7–27). Among the infants in the HFNC group who had treatment failure (n = 35), 32 were initially rescued with CPAP. The rate of mechanical ventilation in the first 3 and 7 days of life was similar between the 2 groups. Treatment failure was significantly higher in the HFNC group per protocol and also in the subgroups of infants with moderate (Silverman Anderson score, SAS ≤5) or severe respiratory distress (SAS score >5). Conclusions: When comparing HFNC to nCPAP as a primary noninvasive respiratory support in preterm infants with respiratory distress, HFNC is inferior to nCPAP in avoiding the need for a higher mode of respiratory support in the first 72 h of life. [ABSTRACT FROM AUTHOR]

Antenatal steroid treatment to enhance fetal lung maturity and surfactant treatment to prevent or treat respiratory distress syndrome have been major advances in perinatal medicine in the past 40 years contributing to improved outcomes for preterm infants. Use of postnatal steroids to prevent or treat chronic lung disease in preterm infants has been less successful and associated with adverse neurodevelopmental outcomes. Although early (in the first week of life) postnatal steroid treatment facilitates earlier extubation and reduces the risk of chronic lung disease, it is associated with adverse effects, such as hyperglycemia, hypertension, gastrointestinal bleeding and perforation, hypertrophic cardiomyopathy, growth failure, and cerebral palsy, and cannot be recommended. Early treatment with hydrocortisone may also improve survival without chronic lung disease, but concerns remain about possible adverse effects such as gastrointestinal perforation and sepsis, particularly in very preterm infants. Early inhaled budesonide also reduces the incidence of chronic lung disease but there are concerns that this may occur at the expense of increased risk of death. More studies of early low-dose steroids with adequate long-term follow-up are needed before they can be recommended for the prevention of chronic lung disease. Late (after the first week of life) postnatal steroids may have a better benefit-to-harm ratio than early steroids. A Cochrane Review shows that late steroid treatment reduces chronic lung disease, the combination of death and chronic lung disease at both 28 days and 36 weeks' corrected age, and the need for later rescue dexamethasone. Adverse effects include hyperglycemia, hypertension, hypertrophic cardiomyopathy, and severe retinopathy of prematurity but without an increase in blindness. Long-term neurodevelopmental effects are not significantly increased by late postnatal steroid treatment. Current recommendations are that postnatal steroid treatment should be reserved for preterm infants who are ventilator-dependent after the first 7-14 days of life and any course should be low dose and of short duration to facilitate endotracheal extubation. Budesonide/surfactant mixtures show some promise as a means of reducing chronic lung disease in preterm infants with severe respiratory distress syndrome, but further larger studies with long-term follow-up are needed before this treatment can be recommended as a routine intervention. [ABSTRACT FROM AUTHOR]

In the last 4 decades, advances in neonatology have led to a significant increase in the survival of preterm infants. One of the biggest advances was the introduction of surfactant replacement therapy for the treatment of respiratory distress syndrome. This is the main cause of respiratory insufficiency in preterm infants and is one of the major causes of perinatal morbidity and mortality. Surfactant replacement therapy is already a well-investigated and established therapy in neonatology. However, surfactant replacement therapy has progressed and been refined over recent decades, especially with the increasing care for preterm infants born before 26 weeks' gestational age and the recent clinical focus on avoiding mechanical ventilation. Clinical evidence is evolving on new types of surfactant, surfactant dosages, co-medication given before, with, or after surfactant replacement, and new technical advances regarding the mode of administration. [ABSTRACT FROM AUTHOR]

Background: A sustained inflation (SI) at birth in preterm babies may be ineffective unless the infants breathe. Gain in lung volume is associated with breathing during delivery room non-invasive management. Objective: To describe the breathing patterns of preterm infants during an SI and correlate to a calculated gain in lung volume. Methods: Retrospective observational study. Data collected from a respiratory function monitor during SI (25 cmH2O for 15 s then PEEP at 5 cmH2O) through a face mask in preterm infants (gestational age [GA] ≤ 31 weeks). Spontaneous breaths, inspiratory time (TI), inspiratory/expiratory tidal volume (Vti/Vte), and gain in lung volume were determined. Results: 30 SIs in 20 infants (mean GA 27 weeks; birth weight 825 g) were analysed and stratified in 2 groups according to spontaneous breathing: SIs without spontaneous breaths (apnoea: n = 11) and SIs with spontaneous breaths (breathing: n = 19). Mean GA was lower in the apnoea group versus the breathing group (25 vs. 27+5 weeks; p = 0.01). Mean birth weight was lower in the apnoea group versus the breathing group (683 vs. 860 g; p = ns). In the breathing group, the mean number of spontaneous breaths was 4 with a mean TI of 0.52 min, the mean Vti/kg was 5.9 mL/kg, and the mean Vt e was 2.7 mL/kg. The calculated mean gain in lung volume was 7.5 mL/kg in the apnoea group and 17.8 mL/kg in the breathing group (p = 0.039). Conclusions: Actively breathing infants during an SI at birth showed a gain in lung volume higher than apnoeic infants. Spontaneous breathing during SI seems to be related to GA. [ABSTRACT FROM AUTHOR]

Although mechanical ventilation via an endotracheal tube has undoubtedly led to improvement in neonatal survival in the last 40 years, the prolonged use of this technique may predispose the infant to development of many possible complications including bronchopulmonary dysplasia. Avoiding mechanical ventilation is thought to be a critical goal, and different modes of noninvasive respiratory support beyond nasal continuous positive airway pressure, such as nasal intermittent positive pressure ventilation and synchronized nasal intermittent positive pressure ventilation, are also available and may reduce intubation rate. Several trials have demonstrated that the newer modes of noninvasive ventilation are more effective than nasal continuous positive airway pressure in reducing extubation failure and may also be more helpful as modes of primary support to treat respiratory distress syndrome after surfactant and for treatment of apnea of prematurity. With synchronized noninvasive ventilation, these benefits are more consistent, and different modes of synchronization have been reported. Although flow-triggering is the most common mode of synchronization, this technique is not reliable for noninvasive ventilation in neonates because it is affected by variable leaks at the mouth and nose. This review discusses the mechanisms of action, benefits and limitations of noninvasive ventilation, describes the different modes of synchronization and analyzes the technical characteristics, properties and clinical results of a flow-sensor expressly developed for synchronized noninvasive ventilation. [ABSTRACT FROM AUTHOR]

Background: Nasal continuous positive airway pressure (NCPAP) is being widely used for the treatment of respiratory distress syndrome (RDS) in preterm infants. However, there are only a few studies which compare different interfaces of NCPAP delivery and their effects on respiratory outcomes. Objective: We aimed to determine whether NCPAP applied with binasal prongs compared to that with a nasal mask (NM) reduces the rate of moderate/severe bronchopulmonary dysplasia (BPD) in preterm infants. Methods: Infants between 26 and 32 weeks' gestation who suffered from RDS and were treated with NCPAP were assessed. Parallel randomization was performed to eligible infants to receive NCPAP either via binasal prongs or NM. Infants were intubated if they fulfilled the predefined failure criteria. Data were collected by using the intention-to-treat principle. Results: One hundred and sixty infants were screened and 149 were randomized. Seventy-five infants in the binasal prong (NP) group and 74 in the NM group were analyzed. Mean gestational ages were 29.3 ± 1.6 vs. 29.1 ± 2.0 weeks (p = 0.55), and birth weights were 1,225 ± 257 vs. 1,282 ± 312 g (p = 0.22) in the NP and NM groups, respectively. The frequency of NCPAP failure within 24 h of life was higher in the NP than the NM group (8 vs. 0%; p = 0.09). The median duration of NCPAP was significantly higher in the NP group [median 4 (1-5) vs. 2 (1-3) h, p < 0.01]. The rate of moderate and severe BPD was significantly lower in the NM (n = 2, 2.7%) when compared with the NP group (n = 11, 14.6%; p < 0.01). The BPD/death rates were not different between the 2 groups (NM group: n = 18 or 24.3%; NP group: n = 19 or 25.3%; p = 0.51). Conclusions: The NM was successfully used for delivering NCPAP in preterm infants, and no NCPAP failure was observed within the first 24 h. These data show that applying NCPAP by NM yielded a shorter duration of NCPAP and statistically reduced the rates of moderate and severe BPD. [ABSTRACT FROM AUTHOR]

Background: Noninvasive ventilation is increasingly used in very-low-birth-weight infants (VLBWI) to reduce complications that occur with invasive ventilation. However, the physiological effects of synchronization during noninvasive nasal intermittent mandatory ventilation (IMV) have not been tested in VLBWI immediately after extubation. Objective: We aimed to study the short-term effects of synchronized nasal IMV (S-NIMV) compared to nonsynchronized nasal IMV (NIMV) on breathing effort as measured by phasic esophageal pressure (Pe) deflection, spontaneous respiratory rate (RR), gas exchange, cerebral tissue oxygen saturation (StO2) and intermittent episodes of bradycardia or hypoxemia in VLBWI recovering from respiratory distress syndrome (RDS). Methods: Fourteen VLBWI recovering from RDS were studied using a randomized cross-over design during both S-NIMV and NIMV (of 2 h each) immediately after extubation. Results: Phasic Pe deflection, spontaneous RR and transcutaneous PCO2 decreased significantly while transcutaneous PO2 and synchrony rate (defined as peak ventilator pressure delivered within the first half of spontaneous inspiration) increased significantly during S-NIMV compared to during NIMV. There was no difference in blood pressure, average arterial oxygen saturation (SpO2), cerebral StO2, fractional tissue oxygen extraction of the brain and severe bradycardia (defined as time with a heart rate <100 beats/min lasting ≥10 s) and in hypoxemic episodes (SpO2 <80%) between the two modes. Conclusion: Synchronization during nasal ventilation immediately after extubation in VLBWI recovering from RDS improved gas exchange and decreased the respiratory effort, and it could therefore be considered to provide a more efficient respiratory support and synchrony. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Surfactant deficiency was identified as the cause of respiratory distress syndrome (RDS) as long ago as 1959. Trials of surfactant replacement in the 1960s were unsuccessful because the preparations used contained only phospholipids and they were administered inefficiently by nebulization. In the 1970s Bengt Robertson and Göran Enhörning showed that natural surfactant, containing both phospholipids and proteins, could ameliorate the signs of RDS in immature rabbits. In the 1980s Bengt Robertson and Tore Curstedt developed a porcine surfactant, Curosurf® (named after their surnames), which was effective in immature animals and was used in a pilot clinical trial beginning in 1983. Subsequent randomized clinical trials were planned a year later by Bengt Robertson, Tore Curstedt and Henry Halliday, and the first trial was begun in 1985. This showed that Curosurf reduced pulmonary air leaks and neonatal mortality in preterm infants with severe RDS. A second trial, coordinated by Christian Speer, demonstrated that multiple doses of Curosurf were more effective than a single dose. Subsequent trials conducted by the Collaborative European Multicenter Study Group, which included among others Guilio Bevilacqua, Janna Koppe, Ola Saugstad, Nils Svenningsen and Jean-Pierre Relier, showed that early treatment was more effective than later administration and that infants treated at birth had similar neurodevelopmental status to untreated controls at a corrected age of 2 years. Members of the Collaborative European Multicenter Study Group in Denmark and Sweden performed studies to demonstrate the benefits of a combination of surfactant treatment and early continuous positive airway pressure. Curosurf has also been compared with several synthetic and natural surfactants, and at a dose of 200 mg/kg Curosurf has been shown to be superior to either Survanta® or Curosurf used at a dose of 100 mg/kg. Recently, new-generation synthetic surfactants containing both phospholipids and proteins have been developed. After preclinical testing, CHF5633 (developed by Tore Curstedt and Jan Johansson in collaboration with Chiesi Farmaceutici) has undergone a preliminary first study in humans under the guidance of Christian Speer. If effective, this new surfactant preparation could revolutionize the treatment of preterm infants worldwide as it could be made consistently and safely in almost unlimited quantities. This story of a porcine surfactant preparation has been truly remarkable, and many thousands of preterm babies worldwide are now alive and well because of it. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: It would be advantageous for the treatment of neonatal respiratory distress syndrome if effective amounts of surfactant could be delivered by nebulization. Objective: To investigate lung deposition and distribution of nebulized porcine surfactant using an investigational eFlow® neonatal nebulizer. Methods: While lying on one side, 1-day-old piglets inhaled 200 mg·kg-1 of nebulized surfactant via mask, nasal prongs, or tracheal tube. The surfactant was diluted with normal saline to 40 mg·ml-1 and labeled with 99mtechnetium-labelled nanocolloid. Undiluted surfactant (80 mg·ml-1) was instilled tracheally in a fourth group. Each group had 8 animals. Lung deposition was measured by gamma scintigraphy, and deposition values were presented as a percentage of the nebulized or instilled dose. Results: The median lung deposition of inhaled surfactant was 5% (range 3-16) via mask, 14% (2-40) via prongs, and 45% (25-56) via tracheal tube (p < 0.05). It was 88% (71-96) with instillation. In all groups, the surfactant preferentially went to the dependent lung. Deposition ratios (upper lung/both lungs) were 0.32 (0.13-0.58), 0.15 (0.05-0.58), 0.16 (0.11-0.23), and 0.08 (0.03-0.46). Conclusions: Using this nebulizer, the lung depositions of porcine surfactant were 45% via endotracheal tube and 14% via nasal-continuous positive airway pressure (prongs). These figures might be physiologically relevant, but still have to be confirmed in efficacy studies. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

There is mounting evidence that early continuous positive airway pressure (CPAP) from birth is feasible and safe even in very preterm infants. However, many infants will develop respiratory distress syndrome (RDS) and require surfactant treatment. Combining a noninvasive ventilation approach with a strategy for surfactant administration is important to ensure optimal outcome, but questions remain about the optimal timing, mode of delivery and value of predictive tests for surfactant deficiency. Key findings in this review include the following: (1) a noninvasive ventilation strategy with CPAP from birth has a similar outcome to routine intubation in the delivery room; (2) prophylactic surfactant treatment has no advantage over early CPAP with selective surfactant administration; (3) surfactant during CPAP can be safely administered by rapid intubation-extubation (the INSURE method or via tracheal placement of a thin catheter), and (4) predictive tests for surfactant deficiency are being developed and might in future aid in directing surfactant treatment to infants at risk of developing severe RDS. A strategy for surfactant administration should be part of a noninvasive ventilation approach for preterm infants at risk of developing significant RDS. The different methods for surfactant administration during CPAP are reviewed here. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Airway medications are frequently used in the care of the sick neonate. The most prominent airway medication, surfactant for respiratory distress syndrome, will be discussed elsewhere in this issue of Neonatology. Other indications for airway medications have included the prevention and treatment of bronchopulmonary dysplasia, pulmonary hypertension, persistent atelectasis, transient tachypnea of the newborn and upper airway edema. Indications such as the prevention of bronchopulmonary dysplasia are currently the focus of a large multicenter international trial. Other indications require further study. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Despite recent advances in the perinatal management of neonatal respiratory distress syndrome (RDS), controversies still exist. We report updated recommendations of a European Panel of expert neonatologists who developed consensus guidelines after critical examination of the most up-to-date evidence in 2007 and 2010. This second update of the guidelines is based upon published evidence up to the end of 2012. Strong evidence exists for the role of antenatal steroids in RDS prevention, but it is still not clear if the benefit of repeated courses on respiratory outcomes outweighs the risk of adverse outcomes in the short and long term. Many practices involved in preterm neonatal stabilization at birth are not evidence based, including oxygen administration and positive pressure lung inflation, and they may at times be harmful. Surfactant replacement therapy is crucial in the management of RDS but the best preparation, optimal dose and timing of administration at different gestations is not completely clear. In addition, use of very early continuous positive airway pressure (CPAP) has altered the indications for prophylactic surfactant administration. Respiratory support in the form of mechanical ventilation may be lifesaving but can cause lung injury, and protocols should be directed at avoiding mechanical ventilation where possible by using non-invasive respiratory support such as CPAP. For babies with RDS to have best outcomes, it is essential that they have optimal supportive care, including maintenance of normal body temperature, proper fluid management, good nutritional support, appropriate management of the ductus arteriosus and support of the circulation to maintain adequate tissue perfusion. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Analysis of breath-to-breath variability of respiratory characteristics provides information on the respiratory control. In infants, the control of end-expiratory lung volume (EELV) is active and complex, and it can be altered by respiratory disease. The pattern of EELV variability may reflect the behavior of this regulatory system. Objectives: We aimed to characterize EELV variability in premature infants, and to evaluate variability pattern changes associated with respiratory distress and ventilatory support. Methods: EELV variations were recorded using inductance plethysmography in 18 infants (gestational age 30-33 weeks) during the first 10 days of life. An autocorrelation analysis was conducted to evaluate the 'EELV memory', i.e. the impact of the characteristics of one breath on the following breaths. Results: In infants without respiratory symptoms, EELV variability was high, with large standard deviations of EELV. Autocorrelation was found to be significant until a median lag of 7 (interquartiles: 4-8) breaths. Autocorrelation was markedly prolonged in patients with respiratory distress or ventilatory support, with a higher number of breath lags with significant autocorrelation (p < 0.01) and higher autocorrelation coefficients (p < 0.05). Conventional assisted ventilation does not re-establish a healthy EELV profile and is associated with lower respiratory variability. Conclusions: In premature infants, EELV variability pattern is modified by respiratory distress with a prolonged 'EELV memory', which suggests a greater instability of the control of EELV. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

A noninvasive approach in the delivery room in place of intubation and mechanical ventilation can reduce rates of bronchopulmonary dysplasia and death. Nevertheless, the rate of nasal continuous positive airway pressure failure still remains high. In order to prevent lung injury and to enhance the success of continuous positive airway pressure, sustained inflation (administration by face mask or nasopharyngeal tube of a high peak pressure of 20-25 cm H2O, maintained for 10-15 s) has been recently proposed to establish an early and efficient functional residual capacity in the delivery room. Sustained inflation is an intriguing therapy, although the results of clinical trials are controversial in terms of respiratory outcomes. A critical role in the success of sustained inflation could be the presence of open or closed glottis and the contribution of spontaneous breathing that allows air to enter the lungs during the maneuver. Recent neonatal resuscitation guidelines suggest that sustained inflation may be considered in individual clinical circumstances or research settings. Respiratory distress syndrome (RDS) is the most common respiratory pathology in preterm infants and bronchopulmonary dysplasia (BPD) remains an important sequela in these patients. In the past, conventional mechanical ventilation or high-frequency oscillatory ventilation plus surfactant replacement therapy have been considered the standard approach for management of RDS. However, we know that lung injury is directly related to duration of mechanical ventilation and therefore noninvasive approaches [e.g. nasal continuous positive airway pressure (CPAP)] often associated with surfactant administration have been demonstrated to be a valid alternative [1]. Two recent meta-analyses suggest that a noninvasive approach from the delivery room instead of intubation and mechanical ventilation can reduce rates of BPD and death with a number needed to treat of 35 and 25, respectively, in very preterm infants [2, 3]. Nevertheless, the rate of CPAP failure remains high. In fact, recent randomized controlled trials (RCTs) reported that more than 50% of very low birth weight infants initially assisted in the delivery room with nasal CPAP required mechanical ventilation in the neonatal intensive care unit [4-6]. [ABSTRACT FROM AUTHOR]

AbstractRespiratory distress syndrome (RDS) is the most common cause of respiratory insufficiency in preterm infants, especially those born at 1,200 g and as an aerosol preparation are currently in progress.Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

AbstractBackground: There is insufficient data to reliably assess the benefit of bronchodilators in ventilated premature neonates. Objectives: To compare the efficacy/tolerance of inhaled ipratropium bromide (IB) vs. terbutaline (T) and to describe factors associated with their efficacy. Methods: A cross-over randomized controlled double-blind trial including intubated neonates with respiratory distress syndrome. Two puffs of IB or T were administered at 0, 20, 40 min. Passive respiratory system resistance (Rrs) and compliance (Crs) were measured at 0, 20, 40, 60 min. A positive response was defined as a >2 individual coefficients of variation decrease in Rrs or increase in Crs. Results: Twenty-one infants (gestational age (mean ± SD): 27.3 ± 1.6 weeks; birth weight: 947 ± 250 g; postnatal age: 20 ± 9 days) were included. At 60 min, no treatment effect for Rrs and Crs could be identified (cross-over analysis). Overall data (irrespective of order of administration) showed that after 6 puffs, the decrease in Rrs was greater in the IB vs. T group (–17.0 ± 22.2% vs. –11.3 ± 26.7%, respectively (NS)). Thirty-eight percent of infants responded to IB vs. 43% to T. However, in 19% of patients, decreased Crs was observed after 6 puffs of T. No marker of a positive or paradoxical response could be identified. Treatment was well-tolerated. Conclusion: High doses of bronchodilators are required in ventilated neonates, but the positive response rate was <50%. Their long-term benefit remains to be proven.Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Clinical trials have confirmed that surfactant therapy is effective in improving the immediate need for respiratory support and the clinical outcome of premature newborns. Trials have studied a wide variety of surfactant preparations used either to prevent (prophylactic or delivery room administration) or treat (selective or rescue administration) respiratory distress syndrome (RDS). Using either treatment strategy, significant reductions in the incidence of pneumothorax, as well as significant improvement in survival, have been noted. It is unclear whether there are any advantages to treating infants with respiratory insufficiency earlier in the course of RDS. Objectives: To compare the effects of early versus delayed selective surfactant therapy for newborns intubated for respiratory distress within the first 2 h of life. Planned subgroup analyses included separate comparisons for studies utilizing natural surfactant extract and synthetic surfactant. Search Methods: We searched the Oxford Database of Perinatal Trials, MEDLINE (MeSH terms: pulmonary surfactant; text word: early; limits: age, newborn: publication type, clinical trial), PubMed, abstracts, conference and symposia proceedings, expert informants, and journal handsearching in the English language. For the updated search in April 2012, we searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2012, Issue 1) and PubMed (January 1997 to April 2012). Selection Criteria: Randomized and quasi-randomized controlled clinical trials comparing early selective surfactant administration (surfactant administration via the endotracheal tube in infants intubated for respiratory distress, not specifically for surfactant dosage) within the first 2 h of life versus delayed selective surfactant administration to infants with established RDS were considered for review. Data Collection and Analysis: Data regarding clinical outcomes were excerpted from the reports of the clinical trials by the review authors. Subgroup analyses were performed based on type of surfactant preparation, gestational age, and exposure to prenatal steroids. Data analysis was performed in accordance with the standards of the Cochrane Neonatal Review Group. Main Results: Six randomized controlled trials met selection criteria. Two of the trials utilized synthetic surfactant (Exosurf Neonatal) and four utilized animal-derived surfactant preparations. The meta-analyses demonstrate significant reductions in the risk of neonatal mortality (typical risk ratio (RR) 0.84; 95% confidence interval (CI) 0.74-0.95; typical risk difference (RD) -0.04; 95% CI -0.06 to -0.01; 6 studies; 3,577 infants), chronic lung disease (typical RR 0.69; 95% CI 0.55-0.86; typical RD -0.04; 95% CI -0.06 to -0.01; 3 studies; 3,041 infants), and chronic lung disease or death at 36 weeks (typical RR 0.83; 95% CI 0.75-0.91; typical RD -0.06; 95% CI -0.09 to -0.03; 3 studies; 3,050 infants) associated with early treatment of intubated infants with RDS. Intubated infants randomized to early selective surfactant administration also demonstrated a decreased risk of acute lung injury including a decreased risk of pneumothorax (typical RR 0.69; 95% CI 0.59-0.82; typical RD -0.05; 95% CI -0.08 to -0.03; 5 studies; 3,545 infants), pulmonary interstitial emphysema (typical RR 0.60; 95% CI 0.41-0.89; typical RD -0.06; 95% CI -0.10 to -0.02; 3 studies; 780 infants), and overall air leak syndromes (typical RR 0.61; 95% CI 0.48-0.78; typical RD -0.18; 95% CI -0.26 to -0.09; 2 studies; 463 infants). A trend toward risk reduction for bronchopulmonary dysplasia or death at 28 days was also evident (typical RR 0.94; 95% CI 0.88-1.00; typical RD -0.04; 95% CI -0.07 to -0.00; 3 studies; 3,039 infants). No differences in other complications of RDS or prematurity were noted. Only two studies reported on infants under 30 weeks' gestation. Decreased risk of neonatal mortality and chronic lung disease or death at 36 weeks' postmenstrual age was noted. [ABSTRACT FROM AUTHOR]

No abstract available Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]