Comparison of Outcomes according to the Time of Initial Surfactant Treatment for Very Low Birth Weight Infants: A Multicenter Study

Abstract

Purpose : The prophylactic surfactant treatment has been found to improve patient outcomes, compared to the rescue treatment. We performed a multicenter study to determine the relationship between the timing of the initial surfactant treatment and patient outcomes. Methods : One hundred and seventy one neonates, born at eight different centers, from January 1, 2004 to December 31, 2005, were enrolled. The included subjects were gestational age less than 34 weeks, birth weights less than 1500 g and had respiratory distress syndrome (RDS) that received surfactant. First, a group that received surfactant within two hours after birth was compared to a group that received surfactant after two hours. Next, a group that received surfactant within 30 minutes after birth was compared to a group that received surfactant after 30 minutes. Results : The mean time after birth at which the initial surfactant was administered to neonates was 140.0 ± 114.3 minutes. The incidence of patent ductus arteriosus (PDA), duration of ventilatory support and hospital days were significantly reduced in the group that received surfactant within two hours after birth. The incidence of PDA and duration of ventilatory support were significantly reduced in the group that received surfactant within 30 minutes after birth. Conclusion : Surfactant treatment should be provided to premature infants, as soon as possible.

목적 : 미숙아에서 호흡곤란증후군으로 진단 후에 치료하는 것보다 예방적으로 일찍 폐표면활성제를 투여하였을 때 환자들의 예후가 좋다는 것이 많이 보고되고 있다. 저자들은 다기관 연구를 통해 초기 폐표면활성제 투여의 시간과 그에 따른 결과를 비교 분석하였다. 방법 : 2004년 1월부터 2005년 12월까지 8개의 병원에서 태어난 출생체중 1,500 g 미만, 재태연령 34주미만의 환아들 중 호흡곤란증후군으로 진단된 환아들 171명을 대상으로 하였다. 우선 폐표면활성제 투여시간을 출생 후 2시간을 기준으로 나누어 군간 비교 분석하였고, 그 다음으로 투여시간을 출생 후 30분을 기준으로 나누어 군간 결과를 비교 분석하였다. 결과 : 환아들의 초기 폐표면활성제 투여시간은 평균 140.0±114.3분이었다. 동맥관개존증 발생률, 인공호흡기기간, 입원기간은 출생 후2시간 이내에 폐표면활성제를 투여한 군이2시간이후에 투여한 군에 비해 통계적으로 의미있게 적었다. 30분이내에 폐표면활성제를 투여한 군도 30분이후에 투여한 군에 비해 동맥관개존증 발생률과 인공호흡기간이 의미있게 감소하였다. 결론 : 미숙아에서 폐표면활성제는 출생 후 가능한 빠른 시간내에 투여하는 것이 좋다.