Surfactant replacement therapy for RDS – Experience of a NICU of private set-up

M Monir Hossain1, Mahfuza Shirin1, Shaheen Akter2, Md. Delwar Hossain3, MohammadbAbdullah Al Mamun4, Md. Nurul Akhtar Hassan4, Fahmida Zabin5, Manifa Afrin6, Ismat Jahan6, Sultana Razia6, Kazi Shahriar Alam6, Farzana Azad7
Background: Respiratory distress syndrome (RDS) is a major cause of mortality
and morbidity in preterm neonates. Exogenous surfactant replacement therapy has
been a part of the routine care of preterm neonates with RDS since 1990s. Recently
surfactant became commercially available in Bangladesh.
Objectives: To evaluate the outcome of surfactant replacement therapy in newborns
with respiratory distress syndrome (RDS) in a Bangladeshi set up.
Materials and Methods: Twenty seven preterm babies of less than 35 weeks gestation
with clinical and radiological signs of respiratory distress syndrome (RDS) hospitalized in
the NICU of Aysha Memorial Hospital from July 2008 to June 2009 were included in this
prospective study. All included neonates were treated with one dose of bovine surfactant
(Newfactan) as rescue therapy. Surfactant was administered by using standard procedure
of surfactant instillation. Effects of surfactant therapy were assessed based on oxygen
saturation (determine by pulse oximetry), gas analyses in arterial blood, the clinical condition
of the child and in relation to time of administration and gestational age.
Results: Mean age on admission was 3.7±2.3 hours. Mean age of surfactant
administration was 6.5±2.5 hours, of them 52% were received surfactant within 10
hours of age. The efficacy of therapy was higher in those neonates who received
surfactant within 10 hours of age than those received therapy after 10 hours of age
(13 cases, 92.8% vs. 6 cases, 46.2%; p=0.013). There was a significant (p<0.05) change
in respiratory rate, SpO2, PCO2 and PO2 after administration of surfactant. Mean
duration of respiratory support was 2.25 days and about half (48.1%) neonates were
managed by nasal CPAP. Complications developed in 22% of cases and complications
encountered were pulmonary haemorrhage (11%), sepsis (7.4%) and pneumothorax
(3.7%). Overall, 70% neonates who received exogenous surfactant were survived and
30% died. The rate of mortality was related to gestational age and the highest mortality
was observed in gestational age of less than 30 weeks (p=0.044).
Conclusion: Our study confirmed the benefits of surfactant therapy in preterm babies
with respiratory distress syndrome. Though surfactant is an expensive medicine, but its
use shortened the duration of ventilation, reduced complications and decreased mortality.
Keywords: RDS, surfactant, outcome.

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