Prophylactic or early selective surfactant combined with nCPAP in very preterm infants

Early surfactant followed by extubation to nasal continuous positive airway pressure (nCPAP) compared with later surfactant and mechanical ventilation (MV) reduce the need for MV, air leaks, and bronchopulmonary dysplasia. This randomized, controlled trial investigated whether prophylactic surfactan...

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Veröffentlicht in:Pediatrics (Evanston) 2010-06, Vol.125 (6), p.e1402-e1409
Hauptverfasser: Sandri, Fabrizio, Plavka, Richard, Ancora, Gina, Simeoni, Umberto, Stranak, Zbynek, Martinelli, Stefano, Mosca, Fabio, Nona, José, Thomson, Merran, Verder, Henrik, Fabbri, Laura, Halliday, Henry
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container_end_page e1409
container_issue 6
container_start_page e1402
container_title Pediatrics (Evanston)
container_volume 125
creator Sandri, Fabrizio
Plavka, Richard
Ancora, Gina
Simeoni, Umberto
Stranak, Zbynek
Martinelli, Stefano
Mosca, Fabio
Nona, José
Thomson, Merran
Verder, Henrik
Fabbri, Laura
Halliday, Henry
description Early surfactant followed by extubation to nasal continuous positive airway pressure (nCPAP) compared with later surfactant and mechanical ventilation (MV) reduce the need for MV, air leaks, and bronchopulmonary dysplasia. This randomized, controlled trial investigated whether prophylactic surfactant followed by nCPAP compared with early nCPAP application with early selective surfactant would reduce the need for MV in the first 5 days of life. A total of 208 inborn infants who were born at 25 to 28 weeks' gestation and were not intubated at birth were randomly assigned to prophylactic surfactant or nCPAP within 30 minutes of birth. Outcomes were assessed within the first 5 days of life and until death or discharge of the infants from hospital. Thirty-three (31.4%) infants in the prophylactic surfactant group needed MV in the first 5 days of life compared with 34 (33.0%) in the nCPAP group (risk ratio: 0.95 [95% confidence interval: 0.64-1.41]; P = .80). Death and type of survival at 28 days of life and 36 weeks' postmenstrual age and incidence of main morbidities of prematurity (secondary outcomes) were similar in the 2 groups. A total of 78.1% of infants in the prophylactic surfactant group and 78.6% in the nCPAP group survived in room air at 36 weeks' postmenstrual age. Prophylactic surfactant was not superior to nCPAP and early selective surfactant in decreasing the need for MV in the first 5 days of life and the incidence of main morbidities of prematurity in spontaneously breathing very preterm infants on nCPAP.
doi_str_mv 10.1542/peds.2009-2131
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source MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
subjects Airway management
Babies
Bronchopulmonary Dysplasia - prevention & control
Clinical trials
Continuous Positive Airway Pressure
Humans
Infant, Newborn
Infant, Premature
Pediatrics
Premature birth
Pulmonary Surfactants - therapeutic use
Surfactants
Survival analysis
Ventilation
title Prophylactic or early selective surfactant combined with nCPAP in very preterm infants
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