Background and aims Surfactant replacement therapy is key in the management of neonatal respiratory distress syndrome (RDS). Despite guideline updates on prophylactic surfactant (PS) use are increasingly more restrictive, outcomes remain improving. We aim to study clinical implementation of the 2010 update on management of RDS in very preterm infants in a tertiary NICU.
Methods Retrospective analysis of very preterm infants admitted to our NICU between 2010–2012. European 2010 RDS guidelines were progressively implemented during this period. We were able to compare patient characteristics and clinical outcomes of three groups: A) Fulfilled 2010 guidelines for PS; B) Did not fulfil 2010 guidelines and B1) Were given or B2) Were not given PS.
Results 277 preterms were admitted and divided into 3 groups: A) 75 fulfilled 2010 PS criteria; B1) 84 had PS despite absent criteria; B2) 118 did not have PS. Subgroup B1 had lower GA (29.1/30.3, p < 0.001) and lower BW than subgroup B2 (1175/1297 g, p < 0.01), but no significant differences were found in Apgar scores, CRIB or SNAPPE2. Subgroup B1 had higher rates of invasive ventilation than subgroup B2 (48/29%, p < 0.01), but lower need of rescue surfactant (11/31%, p < 0.002). No significant differences in mortality, chronic lung disease, length of stay or intraventricular haemorrhage were found.
Conclusions All the preterms who fulfilled 2010 criteria were given PS. Considering infants not fulfilling the 2010 criteria, outcomes were not different between those who got PS and those who did not get PS, which seems to supports the stricter enforcement of the guidelines.