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Randomized Controlled Trial
. 2020 Dec;179(12):1913-1920.
doi: 10.1007/s00431-020-03744-y. Epub 2020 Jul 24.

Early surfactant replacement guided by lung ultrasound in preterm newborns with RDS: the ULTRASURF randomised controlled trial

Javier Rodriguez-Fanjul  1 , I Jordan  2   3 , M Balaguer  2 , A Batista-Muñoz  4 , M Ramon  4 , S Bobillo-Perez  2   5
Affiliations
Randomized Controlled Trial

Early surfactant replacement guided by lung ultrasound in preterm newborns with RDS: the ULTRASURF randomised controlled trial

Javier Rodriguez-Fanjul et al. Eur J Pediatr. 2020 Dec.

Abstract

This study aimed to investigate whether using lung ultrasound (LUS) scores in premature newborns with respiratory distress syndrome (RDS) allows for earlier surfactant therapy (within the first 3 h of life) than using FiO2 criteria. This was a randomised, non-blinded clinical trial conducted in a neonatal intensive care unit. The inclusion criteria were newborns with a gestational age of ≤ 32 weeks and RDS. Patients meeting the inclusion criteria were randomly assigned to two groups: the ultrasound group, administered surfactant based on LUS score and/or FiO2 threshold, and the control group, guided by FiO2 only. Fifty-six patients were included. The ultrasound group received surfactant earlier (1 h of life vs. 6 h, p < 0.001), with lower FiO2 (25% vs. 30%, p = 0.016) and lower CO2 (48 vs. 54, p = 0.011). After surfactant treatment, newborns in the ultrasound group presented a greater SpO2 (p = 0.001) and SpO2/FiO2 ratio (p = 0.012).Conclusions: LUS score allowed an earlier surfactant therapy, reduced oxygen exposure early in life and a better oxygenation after the treatment. This early surfactant replacement may lead to reduced oxygen exposure. What is Known: • Lung ultrasound scores predict the need for surfactant therapy in premature newborns. What is New: • This study shows that using lung ultrasound scores improves the timeliness of surfactant replacement compared with using FiO2 alone.

Keywords: Lung ultrasound; Premature newborns; Respiratory distress syndrome; Surfactant.

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Conflict of interest statement

The authors declare that they have no conflicts of interest or financial relationship with any organization.

Figures

Fig. 1.
Fig. 1.
Study protocol algorithm. RDS, respiratory distress syndrome; GA, gestational age
Fig. 2
Fig. 2
Flow chart of patients
Fig. 3
Fig. 3
a Lung ultrasound of a newborn with an LUS score < 8. b Lung ultrasound of a newborn with an LUS score > 8
Fig. 4
Fig. 4
Pie graph representing the proportion of patients who received early surfactant therapy (within the first 3 h of life) in each group
See this image and copyright information in PMC

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