232 The Timing of Surfactant Prophylaxis in Very-Low-Birth-Weight Preterms: Is Earlier Better?

Abstract

Aim To determine whether the immediate bolus strategy treatment could decrease the subsequent need for ventilation compared to the administration of surfactant prophylaxis at 15-minutes. Methods All infants born before 29 weeks', and infants born at 29 to 30 weeks' without antenatal steroid(ANS) were randomized. Infants of group-1 were intubated immediately after birth, of group-2 received standard resuscitation measures, than were intubated at 15-minutes. All received 100 mg/kg surfactant. During these managements infants were ventilated with T-piece(NeoPuff). Then infants were extubated to NCPAP(Infant Flow) if respiratory drive was present. The primary outcome was the need for MV within the first 3-days of life. The secondary outcomes were neonatal morbidities, mortality and duration of hospitalization. Results Total of 80 newborns were enrolled (fourty infants in each group). Prenatal and natal features were similar in groups. Ten infants in group-1, 13 infants in group-2 couldn't be extubated after surfactant. GA and BW of them were lower than the extubated infants. Six infants in group-1, four infants in group-2 needed MV during the first 3-days. Total respiratory support duration was lower in group-1. There were no significant differences between the groups with a respect to PDA, NEC, IVH, sepsis, ROP, BPD, mortality and duration of hospitalization. Conclusion Our study didn't demonstrate a superiority of the immediate bolus strategy of surfactant prophylaxis combined with early-NCPAP to the administration of surfactant at 15-minutes after birth with early-NCPAP. Surfactant prophylaxis at-15 minutes with early-NCPAP seems to be sufficiently effective to yield favorable outcomes in small preterm infants.