Randomised clinical trial of two treatment regimens of natural surfactant preparations in neonatal respiratory distress syndrome.

AIMS: To compare treatment regimens of two widely used natural surfactant preparations Curosurf and Survanta in respiratory distress syndrome (RDS). METHODS: The effects of the two treatment regimens on gas exchange, ventilatory requirements, and 28 day outcome in infants with RDS were compared. Seventy five preterm infants (birth weight 700-1500 g) with RDS requiring artificial ventilation with an FIO2 of > or = 0.4, were randomly selected at 1-24 hours of age. One group received an initial dose of Curosurf (200 mg/kg); the other group Survanta (100 mg/kg). Patients who remained dependent on artificial ventilation with an FIO2 of > or = 0.3 received up to two additional doses of Curosurf (each of 100 mg/kg) after 12 and 24 hours or up to three additional doses of Survanta (each of 100 mg/kg) between six and 48 hours after the initial dose. RESULTS: There was a rapid improvement in oxygenation and ventilatory requirements were reduced in both groups. However, infants treated with Curosurf had a higher arterial:alveolar oxygen tension ratio and required a lower peak inspiratory pressure and mean airway pressure at several time points within 24 hours of randomisation (p < 0.05-0.001). The incidences of pneumothorax in the Curosurf and Survanta groups were 6% and 12.5%, respectively; the corresponding figures for grades 3-4 intracerebral haemorrhage were 3% and 12.5%, respectively. Mortality was 3% in the Curosurf group and 12.5% in the Survanta group. However, these differences did not reach significance. CONCLUSION: The Curosurf treatment regimen resulted in a more rapid improvement in oxygenation than Survanta and reduced ventilatory requirements up to 24 hours after start of treatment. This was associated with a trend towards reduced incidence of serious pulmonary and non-pulmonary complications.

[Mechanical stress of newborn infants caused by incubator transport]. / Mechanische Belastungen Neugeborener bei Inkubatortransporten.

Newborn babies transported in an incubator are obviously exposed to considerable mechanical vibrations. We measured these vibrations with the aim to improve these conditions. The vibrations measured on transportation by R.T.W. ambulance (Daimler-Benz 508 with an "anti-vibration platform") are almost tolerable; however on the K.T.W. ambulance (Volkswagen Type 2) the registered vertical accelerations were much greater and gave an unacceptable level of gravitational forces. Small constructive corrections to the stretcher and the connection between stretcher and incubator lead to a marked decrease in peak acceleration and the value of effective acceleration. We also found that it is of great importance to drive smoothly and that the vibrations are more pronounced with hasty driving. The influence of these vibrations as a possible co-factor in the pathogenesis of intracranial haemorrhage is discussed.

The reliability of pH-values in fetal blood samples - A study of the second stage.

In 119 cases fetal blood analysis (FBA) was done in the last 15 minutes before birth together with blood sampling from the umbilical artery (UA) immediately after delivery before the first breath. Using the measured pH-values we investigated the relationship between these variables, in particular the degree of influence of considerable caput succedaneum on pH-values in peripheral blood. Our investigation was performed during the time just before delivery, when the disturbance of blood circulation in the presenting fetal part whuld have the highest influence on pH-values measured from peripheral blood samples. We kept in mind especially the critiques of FBA by WULF et al. [21] and ASSALI [2]. As other authors have concluded, we found a high degree of correlation between the pH evaluated by FBA and that determined in the umbilical artery blood. The coefficient of correlation was: pHact r=0.82 pHqu40 r=0.78. The relationship between the corresponding pHvalues in peripheral (FBA) and arterial (UA) blood is given in Fig. 1 a and Fig. 1 b. The correlation of quadrants showed for the actual pH as well for the pHqu40 p less than 0.01. As derived form this, a high degree of correlation between the pH-values can be seen. The mean pH-values were: (see article) 42 of the children had a severe or moderate caput succedaneum. Fig. 2a and 2b show the relationship between central and peripheral pH-values in these cases. Again a good correlation between the pH-values was observed as in the whole collective. The coefficient of correlation was: pHact r=0.78 pHqu40 r=0.79. Caput succedaneum seems to have only minimal influence on the pH of blood obtained from the presenting fetal part. These results lead us to conclude that blood sampling from the presenting fetal part in the second stage provides almost indentical pH-values as in the central fetal blood.