A comparison of surfactant as immediate prophylaxis and as rescue therapy in newborns of less than 30 weeks' gestation

Article Abstract:

Premature infants are susceptible to respiratory distress syndrome, a potentially fatal condition, as a result of their inadequate production of pulmonary surfactant (a substance that lines the air sacs of the lungs, lowering their surface tension and preventing lung collapse). This substance, as a medication (exogenous surfactant), can be administered into the airways of prematurely born infants, but whether the prophylactic (preventive) approach or rescue approach is more effective has not been determined. Prophylactic surfactant administration begins immediately after delivery; it may be better distributed within the lungs this way, but using this approach it will unavoidably be given to some infants who would not develop respiratory distress syndrome. Rescue therapy treats only those patients who develop signs of fairly severe respiratory distress syndrome (60 to 70 percent of infants born before 30 weeks' gestation fall into this category). In such cases, lung injury may already have occurred when treatment starts. To compare the effectiveness of the two approaches, infants born after fewer than 30 weeks' gestation at three medical centers were randomly assigned to receive either prophylactic (235 infants) or rescue (244) therapy with surfactant. Survival, respiratory complications (pneumothorax, or lung collapse), and the need for supplemental oxygen were monitored. Results showed a significant advantage to prophylactic surfactant administration: 88 percent of the newborns in this group survived until hospital discharge, compared with 80 percent in the rescue-therapy group. The latter group also experienced a higher rate of pneumothorax. The better survival of the prophylactic group was due primarily to the results for very premature infants (26 gestational weeks or less); 75 percent survived, compared with 54 percent of those who underwent rescue therapy. The administration of surfactant immediately after birth is technically difficult, and the infants in this group had lower one-minute Apgar scores (a measure of physical functioning in newborns) than rescue-therapy patients; however, five-minute Apgar scores were comparable for the two groups. The results support the prophylactic use of surfactant in treating very premature infants. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Infants (Premature), Premature infants, Dosage and administration, Respiratory distress syndrome, Pulmonary surfactant, Pulmonary surfactants

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Fiberoptic bronchoscopy in the treatment of intubated neonates

Article Abstract:

Bronchoscopy is the examination of the bronchial breathing tree using a flexible fiberoptic tube. The advent of ultrathin fiberoptic tubing has allowed physicians to examine the bronchial tubes of sick newborns to see if the tubes used for artificial breathing devices, endotracheal tubes (ETT), were in the correct position. ETT placement can be also assessed by X-ray. To see if fiberoptic bronchoscopy is useful in the diagnosis of airway disease and the position of the ETT, 76 examinations were performed on 65 newborns. The procedure, which takes from 30 to 60 seconds, was well tolerated by the infants. The end affixed with the bronchoscope was difficult to direct into the desired bronchial tube (there are two bronchi) and required skilled direction. A change in the treatment plan for 13 newborns (19 percent) was required after results of the bronchoscopic examination were revealed. Fiberoptic bronchoscopy was useful in determining the position of ETT without exposing the infant to excess radiation from X-ray evaluations. Bronchoscopy is a safe and effective way to diagnose airway disease in newborns on mechanical breathing devices. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Medical examination, Diseases, Infants (Newborn), Medical equipment, Neonatal diseases, Neonatal screening, Respiratory tract diseases, Bronchi, Bronchoscopy

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