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PEDIATRICS Vol. 103 No. 3 March 1999, pp. 684-685
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ABSTRACT |
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Abstract
Recommendation
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Respiratory failure secondary to surfactant deficiency is a major cause of morbidity and mortality in low birth weight immature infants. Surfactant therapy substantially reduces mortality and respiratory morbidity for this population. The statement summarizes the indications for surfactant replacement therapy. Because respiratory insufficiency may be a component of multiorgan dysfunction in sick infants, surfactant should be administered only at institutions with qualified personnel and facilities for the comprehensive care of sick infants.
Exogenous surfactant replacement has been established
as an appropriate preventive and treatment therapy for
prematurity-related surfactant deficiency. Surfactant therapy also may
be indicated for more mature infants with primary pulmonary
hypertension or meconium aspiration syndrome. Single and multicenter
randomized controlled trials using synthetic, modified animal, purified
animal, and human surfactants have shown that the use of surfactant
replacement in preventive or treatment modes has been safe and
efficacious.1-18 Reduced mortality rates and improved
short-term respiratory status for preterm infants with
surfactant-deficiency respiratory distress have been confirmed.
However, coexistent morbidity, such as necrotizing enterocolitis,
nosocomial infections, patent ductus arteriosus, intraventricular
hemorrhage, and chronic lung disease, appear primarily unaffected.
Reports of long-term outcome for infants enrolled in the randomized
surfactant trials and evaluated at 1 to 2 years of age have shown
neither beneficial nor adverse effects of surfactant use on growth
and/or neurodevelopmental parameters.19-26
Current studies continue to address refinements in surfactant use that
may optimize its effectiveness. New products, timing, dosage, methods
of administration, and modification for particular gestational age
groups are among the issues that may improve the effect of surfactants.
Two surfactants, one synthetic and the other modified bovine, have been
licensed and are available commercially in the United States.
Universal availability of these products raises the concern that
surfactants may be used to address the respiratory component of
multisystem disorders that affect high-risk, low birth weight infants
when other diseases cannot be addressed appropriately. This is a
critical issue because the target population for surfactant therapy is
primarily the high-risk, low birth weight infants who may have
multisystem disorders that are not affected beneficially by treatment
with surfactants. Caring for these infants in nurseries without the
full range of capabilities required may affect the overall outcome
adversely.27,28 As systems of neonatal health care adapt
to modified patterns of disease in low birth weight infants, the
following recommendations should be incorporated.
1. Surfactant replacement therapy should be directed by
physicians qualified and trained in its use and administration.
Qualifications should include experience in management of the
respiratory care of low birth weight infants, particularly those on
mechanical ventilation.
COMMITTEE ON FETUS AND NEWBORN, 1998-1999
LIAISON REPRESENTATIVES
SECTION LIAISONS
CONSULTANTS
RECOMMENDATIONS
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Abstract
Recommendation
References
2. Nursing and respiratory therapy
personnel experienced in the management of low birth weight infants,
including mechanical ventilation, should be available within the unit
at the bedside when surfactant therapy is
administered.
3. Equipment necessary for managing and
monitoring the condition of low birth weight infants, including that
needed for mechanical ventilation, should be available on-site when
surfactant therapy is administered. Radiology and laboratory support to
manage a broad range of needs of these infants should be
available.
4. More important, surfactant therapy should be
used only in institutions in which facilities and personnel are
available for the management of multisystem disorders and low birth
weight infants.
5. An institutionally approved surfactant
therapy protocol, which is a mandatory component of the quality
assurance program for neonates, should exist.
6. In the
institutions not satisfying recommendations 2 through 5, and when
timely transfer to an appropriate institution cannot be achieved,
surfactant therapy may be given, but only by a physician skilled in
endotracheal intubation. Under these circumstances, consultation with a
subspecialty center should be obtained. Infants should be transferred
from such institutions if appropriate and when feasible to a center
with appropriate facilities and staff trained to care for multisystem
morbidity in low birth weight infants.
James A. Lemons, MD, Chairperson
Lillian R. Blackmon, MD
William P. Kanto, Jr, MD
Hugh M. MacDonald, MD
Carol A. Miller, MD
Lu-Ann Papile, MD
Warren Rosenfeld, MD
Craig T. Shoemaker, MD
Michael E. Speer, MD
Michael F. Greene, MD
American College of Obstetricians and Gynecologists
Patricia Johnson, RN, MS, NNP
American Nurses Association, Association of Women's Health,
Obstetric and Neonatal Nurses,
National Association of Neonatal Nurses
Douglas D. McMillan, MD
Canadian Paediatric Society
Solomon Iyasu, MBBS, MPH
Centers for Disease Control and Prevention
Linda L. Wright, MD
National Institutes of Health
Richard Molteni, MD
Section on Perinatal Pediatrics
Jacob C. Langer, MD
Section on Surgery
Marilyn Escobedo, MD
Avroy Fanaroff, MD
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FOOTNOTES |
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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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REFERENCES |
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Abstract
Recommendation
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The following policy statement is a revision:
This article has been cited by other articles:
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  W. A. Engle and and the Committee on Fetus and Newborn Surfactant-Replacement Therapy for Respiratory Distress in the Preterm and Term Neonate Pediatrics, February 1, 2008; 121(2): 419 - 432. [Abstract] [Full Text] [PDF]
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 F Sandri, G Ancora, A Lanzoni, P Tagliabue, M Colnaghi, M L Ventura, M Rinaldi, I Mondello, P Gancia, G P Salvioli, et al. Prophylactic nasal continuous positive airways pressure in newborns of 28-31 weeks gestation: multicentre randomised controlled clinical trial Arch. Dis. Child. Fetal Neonatal Ed., September 1, 2004; 89(5): F394 - F398. [Abstract] [Full Text] [PDF]
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J. D. Horbar, J. H. Carpenter, J. Buzas, R. F. Soll, G. Suresh, M. B. Bracken, L. C. Leviton, P. E. Plsek, J. C. Sinclair, and for the members of the Vermont Oxford Network Timing of Initial Surfactant Treatment for Infants 23 to 29 Weeks' Gestation: Is Routine Practice Evidence Based? Pediatrics, June 1, 2004; 113(6): 1593 - 1602. [Abstract] [Full Text] [PDF]
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 R. Bruni Focus on proteins, surfaces, et al. Am J Physiol Lung Cell Mol Physiol, November 1, 2002; 283(5): L894 - L896. [Full Text] [PDF]
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