Clinical course of premature infants intubated in the delivery room, submitted or not to porcine-derived lung surfactant therapy within the first hour of life

Abstract

Objectives: The aim of this study was to perform a comparative analysis of the clinical outcome, gasometric course and ventilatory indices of premature infants with a gestational age of < or = 34 weeks who were intubated in the delivery room, owing to respiratory insufficiency, according to whether or not they were submitted to porcine-derived lung surfactant therapy within the first hour of life.

Methods: The study was randomized and controlled. A total of 75 premature infants were classified into two groups: group A, comprising 35 neonates who were submitted to surfactant within the first hour of life; and group B, comprising 40 neonates who were not submitted to surfactant within the first hour of life.

Results: Exogenous surfactant therapy after establishment of respiratory distress syndrome (RDS) was necessary in eight neonates of group A (22.9%) and 31 neonates of group B (77.5%) (p < 0.001). The neonates in group A presented higher levels in relation to group B for the variables: partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) and PaO2/partial pressure of alveolar oxygen (PAO2), while neonates in group B presented higher levels for FiO2, PAO2 and difference D(A - a)O2 in relation to group A. Weight affected the oxygenation index (OI) parameter, in that neonates with lower weight presented greater values of the OI.

Conclusions: In premature infants with established RDS, the need for exogenous surfactant was lower in the group that received surfactant within the first hour of life. Furthermore, the gasometric parameters and ventilatory indexes presented a better course in the first 24 h of life among premature infants who received exogenous surfactant within the first hour of life, in relation to those who did not.