A population study: mortality and morbidity after availability of surfactant therapy

Objective: To assess the impact of recent changes in neonatal intensive care on the mortality and morbidity of very-low-birth-weight neonates (< 1501 g). Design: Prospective cohort study. Setting: Six neonatal intensive care units in Wisconsin and Iowa. Participants: All very-low-birth-weight neonates who were admitted to the neonatal intensive care units the year before the availability of exogenous surfactant (n = 333), during the investigational new drug protocol for synthetic surfactant (Exosurf) (n = 347), and after the release of synthetic surfactant (n = 356) (designated as periods 1, 2, and 3, respectively). Interventions: None. Main Results: The percentage of neonates receiving exogenous surfactant in the three periods was 3%, 37%, and 56%, and the percentage receiving antenatal steroids was 12%, 17%, and 27% (P = .0001 for increase in both modalities). The percentage of neonates dying in the three periods was 23%, 14%, and 19% (P = .05 for downward trend). The percentage of neonates with intraventricular hemorrhage decreased in the subgroup weighing between 700 and 1350 g (35%, 28%, and 24%) (P = .04) and increased in the subgroup weighing below 700 g (8%, 41%, and 45%) (P = .03). The percentage of neonates with bronchopulmonary dysplasia increased from 21% to 36% between periods 1 and 2 (P = .003) and decreased to 27% (P = .04) in period 3. Anteratal steroid use was strongly associated with the decrease in intraventricular hemorrhage (odds ratio, 0.35) and mortality risk (odds ratio, 0.20). Conclusions: Several developments in care have contributed to changes in mortality risk, incidence of intraventricular hemorrhage, and the severity of respiratory disease in very-low-birth-weight infants. (Arch Pediatr Adolesc Med. 1994;148:1295-1301)
The widespread use of surfactant and other new neonatal therapies has affected the rate of complications and death among very-low-birth-weight (VLBW) newborns. Researchers reviewed the medical records of 1,036 VLBW newborns who were admitted to one of six neonatal intensive care units. Of these, 333 were treated before surfactant was available, 347 were treated during the pre-market testing of surfactant, and 356 were treated after surfactant was approved for use. Surfactant was administered to 3% of infants in the first group, 37% in the second group, and 56% in the third group. Corticosteroids were prescribed for 12% of infants in the first group, 17% in the second group, and 27% in the third group. The number of newborns who died decreased significantly from the first to the third group. The rate of brain hemorrhage in infants weighing between 700 and 1,350 grams also decreased from the first to the third group, although this trend was reversed in infants weighing less than 700 grams.