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Surfactants Feasible for Self-Breathing Preterm Infants

Decrease the need for mechanical ventilation in preterm infants breathing spontaneously on CPAP

FRIDAY, Sept. 30 (HealthDay News) -- Application of surfactant to spontaneously breathing preterm infants stabilized with continuous positive airway pressure (CPAP) is feasible, and reduces the need for mechanical ventilation, according to a study published online Sept. 30 in The Lancet.

Wolfgang Göpel, M.D., from the University of Lübec in Brussels, Belgium, and colleagues investigated whether mechanical ventilation could be avoided by a new method of surfactant application in 220 spontaneously breathing preterm infants with a gestational age between 26 and 28 weeks, and a birth weight less than 1.5 kg. A total of 112 infants randomly received standard treatment, and 108 received surfactant treatment during spontaneous breathing. Infants were stabilized with CPAP, and received rescue intubation if required. The primary outcome was either mechanical ventilation use, or no mechanical ventilation with a fraction of inspired oxygen >0.60, partial pressure of carbon dioxide >65 mm Hg, or both for two hours between the age of 25 to 72 hours.

The investigators found that mechanical ventilation was required on the second and third day after birth in 28 and 46 percent of the infants in the intervention and standard-therapy group, respectively (absolute risk reduction, 0.18), and in 33 and 73 percent of infants, respectively, during their hospital stay. Compared to infants in the standard treatment group, those in the intervention group had significantly fewer median days on mechanical ventilation (0 versus 2 days), and a lower need for oxygen therapy at 28 days (20 versus 49 percent). The groups showed no differences in mortality and serious adverse effects.

"Application of surfactant to spontaneously breathing preterm infants is feasible and reduces the need for subsequent mechanical ventilation," the authors write.

One of the study authors disclosed financial ties to the surfactant-producing companies Abbott, Chiesi, Nycomed, Boehringer, and Altana. The study was partially funded by Chiesi Pharmaceuticals.

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