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Respiratory distress syndrome in premature infants (RDS) results in severely impaired breathing and is the leading cause of death in premature infants born in the US. Pulmonary surfactant is a phosphate and lipid compound that lowers the surface tension of the air and liquid emulsion in the lungs. Surfactant has been administered to prevent RDS in high-risk infants or to treat infants with confirmed RDS. The effect of timing of administering surfactant on the outcome of RDS was assessed in 182 infants who were born at fewer than 30 weeks gestation. Subgroups of 60 infants in each were designated and were given surfactant at birth; surfactant at less than six hours of age; or received no surfactant. Surfactant was not given to infants with clear chest X-rays and whose who did not require supplemental oxygen. Twenty-eight of 60 infants assigned to the late surfactant group, or the group receiving treatment at less than six hours of age, did not require surfactant. The remaining 31 infants of the late surfactant group required surfactant at an average of 2.9 hours of age. Infants treated with surfactant had better gas exchange, and lower incidence of pulmonary air leak and severe chronic lung disease compared with untreated infants. The infants receiving early and late surfactant treatment had similar measures of lung function, although the early treatment group had a higher frequency of mild chronic lung disease. In addition, infants receiving late surfactant treatment required shorter duration of intensive medical treatment and oxygen support. These findings show that surfactant treatment of infants born at less than 30 weeks' gestation decreases the requirements for oxygen and supportive breathing interventions during the first week of life, and also decreases the incidence of pulmonary air leak and severe chronic lung disease. Prophylactic treatment with surfactant was associated with a higher incidence of mild chronic lung disease compared with those receiving late treatment. These results indicate that prophylactic surfactant treatment may not be routinely needed among premature infants. (Consumer Summary produced by Reliance Medical Information, Inc.)

Respiratory distress syndrome (RDS) is the severe impairment of respiration in the premature newborn. This disorder is the leading cause of death among prematurely born infants in the United States. Pulmonary surfactant is a phosphate- and lipid-containing substance that controls the surface tension of air-liquid emulsion present in the lungs. Studies have shown that surfactant helps to prevent or treat respiratory distress syndrome by reducing the oxygen and ventilatory (breathing) requirements of newborns. However, most studies have focused on infants with very low birth weights and have explored the effects of a single or double dose of surfactant. It has been demonstrated that, following a single dose of surfactant, lung function deteriorates after initial improvement. Hence, the effects of multiple doses of surfactant were compared with those of a single dose in treating respiratory distress syndrome in 75 newborns delivered at 30 to 36 weeks' gestation. Oxygenation (oxygen saturation of the blood in the lungs) of the newborns improved within 10 minutes of administering either a single or multiple dose of surfactant. However, oxygenation and ventilation deteriorated within 6 to 12 hours after the first dose of surfactant. This deterioration could be reduced by administering multiple doses of surfactant. Although additional doses of surfactant did not improve ventilatory requirements or the duration of assisted ventilation, additional doses of surfactant were beneficial in sustaining improved oxygenation. These results indicate that surfactant is effective in reducing oxygen and ventilatory requirements in premature infants less than six hours of age with respiratory distress syndrome. The most effective dose and plan for additional treatment requires further investigation. (Consumer Summary produced by Reliance Medical Information, Inc.)