Human surfactant in the treatment of respiratory distress syndrome. A spectrum of clinical responses

Abstract

Surfactant substitution is an incompletely studied, promising approach to treat respiratory distress syndrome (RDS). In this report we describe a spectrum of clinical responses following administration of human surfactant from amniotic fluid to 64 newborn infants. There was apparently no harm when surfactant was given to three infants with "mature" surfactant profile. Altogether 40% of the 42 "immature" small preterm infants (gestational age 26-29 weeks) required only a single dose, and 50% of them required two or three doses for successful treatment. In infants with persistent foetal circulation (6 cases) or hydrops (2 cases), there was only a transient or a small improvement of respiratory function. Most notably, the very small preterm infants (24-26 weeks, 15 cases) may require substantial increase in blood volume to prevent cardiac failure during the first neonatal day. We propose that the clinical response to exogenous surfactant can be improved by modifying the current management of very small preterm infants.