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Late surfactant use reduces 1-year infant respiratory morbidity

Newborn patients who received a late surfactant while on mechanical ventilation had a reduced respiratory morbidity at 1-year follow-up, according to results from a recent clinical trial.

“Late surfactant administration showed an acceptable safety profile and was associated with a better pulmonary outcome than controls at 1 year of age. Evaluation at 36 weeks’ [postmenstrual age (PMA)] or discharge did not show a significant improvement, but because the infants involved in the study had a severe prolonged pulmonary disease at baseline, these times may have been too early to appreciate a significant effect,” Jean-Michel Hascoët, MD, of the department of neonatology at Maternité Régionale Universitaire, Université de Lorraine, in Nancy, France, and colleagues wrote. “However, we cannot exclude that other clinical factors may also be responsible for part of the observed differences.”

Hascoët and colleagues performed a double blind, randomized clinical trial composed of 118 neonates (55% boys) aged younger than 33 weeks’ gestation and on mechanical ventilation at day 14 after birth, according to the abstract. The researchers administered 200 mg/kg of poractant alfa or placebo and then asked pediatricians not aware of the randomization to examine the infants at 1-year follow-up.

Fraction of inspired oxygen requirements decreased for up to 24 hours for those who received poractant alfa, but not in the control group (0.36 vs. 0.43; P < .005).

However, Hascoët and colleagues noted a similar bronchopulmonary dysplasia and mortality rate at 36 weeks’ postmenstrual age in the surfactant group (27.1%) and the control group, according to the abstract. After discharge, fewer infants in the surfactant group required rehospitalization for respiratory problems (28.3%) compared with the control group (51.1%; P = .03). Fewer infants in the surfactant group required respiratory physical therapy (39.5%) compared with the control group (50.0%).

At 1-year follow-up, pediatricians noted no significant differences regarding height, weight and head circumferences for infants in either group, and no significant differences observed regarding neurodevelopment, according to the abstract. – by Jeff Craven

Disclosure: The researchers report no relevant financial disclosures.