Changes of Respiratory Indices and Clinical Response to the Different Modes of Delivery for Administration of Surfactant Replacement Therapy in the Respiratory Distress Syndrome

ABSTRACT

PURPOSE: Factors affecting the response to surfactant replacement therapy are considered as types of surfactant, and strategies of treatment including prophylactic vs rescue therapy, single vs multiple doses, methods of mechanical ventilation, and modes of surfactant delivery. Among those factors, response to surfactant replacement therapy according to the modes of surfactant delivery was rarely studied in the world. In preterm infants with RDS, we studied the efficacy and adverse effects of surfactant replacernent therapy according to the differences in the modes of surfactant delivery. METHOD: Preterm infant weighing 500-2,500g with RDS who required assisted ventilation were divided into two groups. One group is as follows five fractional doses with five positional changes after removal from ventilator by feeding tube technique. The other group is as follows; two fractional doses with two positional changes by side-port adaptor technique. Of the 30 infants enrolled, 15 were randomly assigned to each group. We compared the respiratory indices, chest radiologic response, clinical outcome after surfactant replacement, and adverse effects during dosing procedure. RESULT: There were no diffrences of patient profile between two groups. There were significant improvernent in FiO2, a/APO2, MAP, OI, and chest radiologic response following surfactant replacement therapy in both groups. No significant differences were noted in the adverse effects during dosing procedure and incidence of complication. CONCLUSION: In initial phase of RDS treatment with surfactant replacement therapy, two fractional doses with two positional changes by side-port adaptor technique improve respiratory indices, radiologic response without dernonstrable harmful effects as five fractional doses with five positional changes after removal from ventilator by feeding tube technique, however two fractional dosing procedure is more recommendable because of #more simple and convenient procedure.