High-versus low-threshold surfactant retreatment for neonatal respiratory distress syndrome

John Kattwinkel, Barry T. Bloom, Paula Delmore, Christina Glick, David Brown, Suzanne Lopez, Lynne D Willett, Edmund A. Egan, Mark Conaway, James Patrie

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Surfactant therapy has become an effective standard therapy for infants with respiratory distress syndrome (RDS). The first dose may be given either as prophylaxis immediately after delivery, or as rescue after an infant has developed RDS. Second and subsequent doses are currently recommended by the manufacturers to be administered at minimal levels of respiratory support. Purpose: This study compared the relative efficacy of administering second and subsequent doses of Infasurf surfactant at a low threshold (FI02 >30%, still requiring endotracheal intubation) versus a high threshold (FI02 >40%, mean airway pressure >7 cm H2O) of respiratory support. Methods: A total of 2484 neonates received a first dose of surfactant; 1267 reached conventional retreatment criteria and were randomized to be retreated according to low- or high-threshold criteria. They were then retreated at a minimum of 6-hour intervals each time they reached their assigned threshold until receiving a maximum of 4 total doses. Subjects were stratified by whether they received their first dose by prophylaxis or rescue and by whether their lung disease was considered complicated (evidence of perinatal compromise or sepsis) or uncomplicated. Results: Among the patients randomized, 33% of prophylaxis and 23% of rescue subjects met criteria for the complicated stratum. Although infants allocated to the high-threshold strategy were receiving slightly more oxygen at 72 hours, there was no difference in the number receiving mechanical ventilation at 72 hours or in the secondary respiratory outcomes (requirement for supplemental oxygen or mechanical ventilation at 28 days, supplemental oxygen at 36 weeks' postconceptional age, inspired oxygen concentration >60% at any time). However, there was a significantly higher mortality for infants with complicated RDS who had received retreatment according to the high-threshold strategy. Conclusions: We conclude that equal efficacy can be realized by delaying surfactant retreatment of infants with uncomplicated RDS until they have reached a higher level of respiratory support than is the current standard. We speculate that this would result in a substantial cost-saving from less utilization of drug. Conversely, we believe that infants with complicated RDS should continue to be treated by the low-threshold retreatment strategy, which is currently recommended by the manufacturers of the commercially available surfactants.

Original languageEnglish (US)
Pages (from-to)282-288
Number of pages7
JournalPediatrics
Volume106
Issue number2 I
DOIs
StatePublished - Jan 1 2000

Fingerprint

Newborn Respiratory Distress Syndrome
Retreatment
Surface-Active Agents
Oxygen
Artificial Respiration
Drug Utilization
Intratracheal Intubation
Infant Mortality
Lung Diseases
Sepsis
Newborn Infant
Pressure
Costs and Cost Analysis
Therapeutics

Keywords

  • Respiratory distress syndrome
  • Surfactant
  • Surfactant therapy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Kattwinkel, J., Bloom, B. T., Delmore, P., Glick, C., Brown, D., Lopez, S., ... Patrie, J. (2000). High-versus low-threshold surfactant retreatment for neonatal respiratory distress syndrome. Pediatrics, 106(2 I), 282-288. https://doi.org/10.1542/peds.106.2.282

High-versus low-threshold surfactant retreatment for neonatal respiratory distress syndrome. / Kattwinkel, John; Bloom, Barry T.; Delmore, Paula; Glick, Christina; Brown, David; Lopez, Suzanne; Willett, Lynne D; Egan, Edmund A.; Conaway, Mark; Patrie, James.

In: Pediatrics, Vol. 106, No. 2 I, 01.01.2000, p. 282-288.

Research output: Contribution to journalArticle

Kattwinkel, J, Bloom, BT, Delmore, P, Glick, C, Brown, D, Lopez, S, Willett, LD, Egan, EA, Conaway, M & Patrie, J 2000, 'High-versus low-threshold surfactant retreatment for neonatal respiratory distress syndrome', Pediatrics, vol. 106, no. 2 I, pp. 282-288. https://doi.org/10.1542/peds.106.2.282
Kattwinkel J, Bloom BT, Delmore P, Glick C, Brown D, Lopez S et al. High-versus low-threshold surfactant retreatment for neonatal respiratory distress syndrome. Pediatrics. 2000 Jan 1;106(2 I):282-288. https://doi.org/10.1542/peds.106.2.282
Kattwinkel, John ; Bloom, Barry T. ; Delmore, Paula ; Glick, Christina ; Brown, David ; Lopez, Suzanne ; Willett, Lynne D ; Egan, Edmund A. ; Conaway, Mark ; Patrie, James. / High-versus low-threshold surfactant retreatment for neonatal respiratory distress syndrome. In: Pediatrics. 2000 ; Vol. 106, No. 2 I. pp. 282-288.
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