Children's Health

Initial surfactant treatment to prevent respiratory distress in very premature infants is often delayed in routine practice

A recent study of 341 North American neonatal intensive care units (NICUs) found that prophylactic surfactant therapy was not widely used in 2000 to prevent respiratory distress syndrome (RDS) in infants 23 to 29 weeks' gestational age who are at high risk for RDS due to their underdeveloped lungs. Fewer than 30 percent of infants in the NICUs received the first dose of surfactant within 15 minutes of birth. At many NICUs, no infants were treated within this time frame, and no infants received treatment in the delivery room. Furthermore, at over 25 percent of NICUs in the study, more than 30 percent of infants who were treated with surfactant didn't receive the first dose until more than 2 hours after birth.

The study, which was supported by the Agency for Healthcare Research and Quality (HS10528) also found wide variation among hospitals in use of surfactant for these at-risk infants. For example, at 25 percent of the NICUs, no infants born at the hospital at 24 or 25 weeks' gestation received surfactant in the delivery room in 2000. Yet, at 25 percent of NICUs with the highest delivery room treatment rates, more than three-fourths of similar age infants received surfactant in the delivery room.

There is clearly a gap between evidence from randomized controlled trials that supports prophylactic (in the delivery room or within 15 minutes of birth) or early (within 2 hours of birth) surfactant administration and what is actually done in routine practice at many NICUs, concludes Jeffrey D. Horbar, M.D., of the University of Vermont College of Medicine. Dr. Horbar and his colleagues analyzed data on 47,608 infants cared for at hospitals that participated in the Vermont Oxford Network Database from 1998 to 2000. During this period, the proportion of infants who were treated with surfactant increased slightly (2 percent), and there was a trend toward earlier administration of surfactant. However, there is considerable room for improvement.

See "Timing of initial surfactant treatment for infants 23 to 29 weeks' gestation: Is routine practice evidence based?" by Dr. Horbar, Joseph H. Carpenter, M.S., Jeffrey Buzas, Ph.D., and others, in the June 2004 Pediatrics 113(6), pp. 1593-1602.

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