Repeat doses of surfactant after the prophylactic dose for treatment of RDS are currently recommended by the manufacturers to be administered at minimal levels of respiratory support. Reducing the number of unnecessary repeat doses will represent a significant cost-saving.
We determined if restricting repeat doses of Survanta by using high-threshold criteria for respiratory support increased the risk of the composite primary outcome of BPD or death before hospital discharge.
Methods A total of 140 infants of ≤28 weeks gestation who received prophylactic Survanta soon after birth were reassessed 12 h after the initial dose for retreatment if the infant remained intubated and required at least 40% inspired oxygen with a MAP >10 cm H2O, and compliance of <0.5 ml/cm H2O.
Multivariate analysis identified which risk factors from a set of a priori predictors including the need for Survanta retreatment could predict the primary outcome.
Results Eighty-eight (59%) of 140 infants reached the retreatment criteria and received repeat doses of Survanta. Sixty-eight (49%) infants developed BPD or died. Infants who developed BPD or died were younger and smaller; were more likely to have PDA, NEC or sepsis, longer (>28 days) stay on mechanical ventilation, and receive retreatment with Survanta. On forward stepwise logistic regression analysis of a priori risk factors only the need of ventilation >28 d (p < 0.001, OR 7.3, 95% CI 2.7–19.5) was independently associated with increased risk of primary outcome.
Conclusion Restricting repeat doses of Survanta did not increase the risk of BPD or death in preterm infants with RDS.