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Infants born prematurely have an increased risk of respiratory distress syndrome, a lung disorder, because the lungs are still immature and do not produce adequate quantities of a substance called surfactant. This condition can be fatal. Studies have shown that a natural surfactant derived from other species given once at birth to these infants can reduce the severity of respiratory distress syndrome, but survival rates have not been shown to increase. This study examined whether giving multiple doses of a natural surfactant derived from cows (bovine surfactant) to these infants could increase their chances of surviving respiratory distress syndrome. Infants born at 23 to 29 weeks gestation weighing between 600 and 1,250 grams (1.3 to 2.8 pounds) were included in the study. A total of 430 infants participated, with 210 assigned to the treatment group and 220 to the control group. The treatment group received the surfactant at birth and again when needed (delivered into the trachea, or windpipe), while the control group received a dose of air, which functioned as a placebo. Results showed that in the first 28 days after birth, 1.9 percent of the treated and 15.6 percent of the untreated infants died from respiratory problems, a significant difference. Respiratory distress syndrome developed in 28 percent of the treated and in 56.9 percent of the control infants. The treated infants also had lower rates of developing pulmonary interstitial emphysema, at 23.3 percent versus 36.9 percent for the control group. These results indicate that multiple treatments with a natural surfactant at birth and again when needed can reduce the rates of illness and death from respiratory problems in infants born prematurely. (Consumer Summary produced by Reliance Medical Information, Inc.)

Respiratory distress syndrome (RDS) is a common breathing complication in premature and low-birth-weight infants. It is caused by a deficiency in surfactant, a protein which makes the lungs pliable. When the lungs are inflexible and cannot expand properly, this results in labored breathing and decreased oxygen intake. In an effort to prevent RDS, a natural surfactant can be given to infants at birth. The results of a multicenter trial of single-dose modified bovine surfactant Survanta, a surfactant derived from cows, are reported. Of the 160 low-birth-weight infants (1.7 to 2.8 pounds, or 750 to 1,250 grams) born between 24 and 30 weeks of pregnancy, 79 were treated with Survanta (100 milligrams per kilogram), while 81 were given air without surfactant. All the infants were treated within 37 minutes of birth. The study evaluations, which included chest X-rays, blood gases, inspired oxygen and airway pressure, were assessed over the next 72 hours. The infants receiving Survanta had less severe RDS assessed by chest X-ray findings and improved inspired oxygen than infants receiving no therapy. There was no major difference in the incidence of the most common complications of prematurity, namely necrotizing enterocolitis (tissue death in the intestinal tract), bronchopulmonary dysplasia (development of abnormal lung tissue), pneumothorax (leakage of air from the lungs into the thoracic cavity), intraventricular hemorrhage (bleeding in the spaces of the brain), sepsis (infection) and a patent ductus arteriosus (the maintenance of a connection between the aorta and the pulmonary artery that normally closes after birth). Treated infants had a lower incidence of pneumothorax and an increased incidence of necrotizing enterocolitis. The incidence of all other complications of prematurity were same in the treated and nontreated groups. Survanta therapy improved the inspired oxygen fraction and increased the number of survivors without bronchopulmonary dysplasia in a small subgroup of infants who weighed less than 2.2 pounds (1 kilogram). Although Survanta did not reduce the incidence of RDS complications, it was useful in decreasing the severity of chest X-ray findings and improved oxygenation in the first 72 hours of life. Infants of very low birth weights may benefit the most from Survanta therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objective. Long-term outcome, including school-age function, has been infrequently reported in infants born at ages as young as 23-26 weeks' gestation. The objective of this study is to report outcome on a large cohort of these infants to understand better the risks and factors that affect survival and long-term prognosis. Methods. Records from 1036 infants who were born between January 1, 1986, and December 31, 2000, were analyzed retrospectively by logistic regression to correlate multiple factors with both survival and long-term outcome. A total of 675 surviving infants were analyzed at a mean age of 47.5 months for developmental outcome. A subset of 147 surviving infants who were born before 1991 were followed through school-age years using the University of Vermont Achenbach Child Behavioral Checklist and Teachers Report Form. Longitudinal follow-up was performed comparing 1-year outcome with school-age performance. Results. Gestational age and recent year of birth correlated highly with survival. Maternal nonwhite race, female sex, inborn status, surfactant therapy, single gestation, and secondary sepsis also correlated positively with survival. Normal cranial ultrasound results, absence of chronic lung disease, female sex, cesarean delivery, and increased birth weight correlated favorably with long-term outcome. Infants who were born at 23 weeks were more likely to have severe impairments compared with those who were born at 24-26 weeks. Early follow-up identified most subsequent physical impairments but correlated poorly with school-age function. Conclusions. Survival continues to improve for infants who are born at extremely early gestational ages, but long-term developmental concerns continue to be prevalent. Early outcomes do not reliably predict school-age performance. Strategies that reduce severe intraventricular hemorrhage and chronic lung disease will likely yield the best chances to improve long-term outlook. Pediatrics 2004;113:e1-e6. URL: http://www.pediatrics. org/cgi/content/full/113/1/e1; prematurity, outcome, neurodevelopment, survival, follow-up.

ABSTRACT. A multicenter, prospective randomized controlled trial was performed comparing the efficacy of a single intratracheal dose of modified bovine surfactant extract (Survanta, 100 mg/kg, Abbott Laboratory, North Chicago, IL) with air placebo in preventing respiratory distress syndrome. Infants were enrolled if they were estimated to be between 24 and 30 weeks' gestation, weighed between 750 and 1250 g, and were intubated and stabilized within 15 minutes after birth. A total of 160 infants were treated (79 with surfactant, 81 with air placebo) between 4 and 37 minutes after birth (median time 12 minutes). Of these, 5 infants were excluded from the final analysis. The 72-hour average values for the arterial-alveolar oxygen ratio, fraction of inspired oxygen, and mean airway pressure were calculated from the area under the curve of scheduled values measured throughout 72 hours. Clinical status was classified using five ordered categories (no supplemental oxygen or assisted ventilation, supplemental oxygen only, continuous positive airway pressure or assisted ventilation with intermittent mandatory ventilation less than or equal to 6 breaths/min, assisted ventilation with intermittent mandatory ventilation >6 breaths/ min, death). Chest radiographs at 24 hours were graded for severity of respiratory distress syndrome. Infants receiving Survanta had less severe radiographic changes at 24 hours of age and decreased average fraction of inspired oxygen (31% vs 42%, P = .002) compared with control infants. No differences were noted in the average arterial-alveolar oxygen ratio, mean airway pressure, or clinical status on days 7 and 28. A beneficial effect was noted in the incidence of pneumothorax (P = .057) and an increase was noted in the incidence of necrotizing enterocolitis (P = .052). No differences in incidence of patent ductus arteriosus, intraventricular hemorrhage, sepsis, or bronchopulmonary dysplasia were seen. According to results of a secondary ... [ABSTRACT FROM AUTHOR]