A new study claims that delivering a surfactant though a thin catheter to premature babies with respiratory distress syndrome (RDS) helps them breathe better, reducing the need for mechanical ventilation.

Researchers at the University of Lübeck (Germany), the University of Cologne (Germany) and other institutions in the German Neonatal Network conducted a randomized trial involving 220 infants with a gestational age of 26-28 weeks and a birth weight less than 1.5 kg that were assigned to standard treatment (112 infants) or to intervention via catheter-delivered surfactant (108 infants), if they developed RDS. The primary outcome was the need for any mechanical ventilation, or not being ventilated but having a partial pressure of carbon dioxide (CO2) greater than 65 mm Hg or a fraction of inspired oxygen more than 0.60 for more than two hours, between 25 and 72 hours of age.

The researchers found that on the second or third day after birth, 30 infants (28%) in the intervention group were mechanically ventilated, compared with 51 (46%) in the standard treatment group, which yielded a significant absolute risk reduction of 0.18. Over the whole length of stay, 33% of infants in the intervention group were mechanically ventilated compared with 73% in the standard treatment group. The intervention group also had significantly fewer median days on mechanical ventilation and a lower need for oxygen therapy at 28 days. There were seven deaths and 21 serious adverse events in the intervention group, compared to five deaths and 28 adverse events in the standard treatment group, which was not significantly different. The study was published early online on September 30, 2011, in the Lancet.

“When the study was planned five years ago, this was not existing practice in the majority of neonatal intensive care units in Germany, but numbers of treated infants have rapidly increased,” said corresponding author professor of pediatrics Egbert Herting, PhD, of the University of Lübeck. “Some 20% to 30% of surfactant applications are done now that way in Germany, with increasing interest from all over the world.”

Standard treatment for RDS is to deliver surfactant via endotracheal tube during mechanical ventilation. To avoid the risks of endotracheal intubation, continuous positive airway pressure (CPAP) and noninvasive mechanical ventilation have been used; CPAP alone, however, has had the disadvantage of not allowing delivery of surfactant to these preterm neonates. The study shows that the application of surfactant via a thin catheter to spontaneously breathing preterm infants receiving CPAP reduces the need for mechanical ventilation.

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