Does early surfactant improve outcome in late preterm newborn? Retrospective study in a neonatal intensive care unit

Objective

To compare the early administration of surfactant, before 12 h of life, versus late, in late preterm neonates (born between 34⁺⁰ and 36⁺⁶ weeks of gestation), with moderate-severe respiratory distress.

Design

Retrospective, observational, analytical, case-control study, with late preterm infants admitted between 2012–2021. It is divided into 2 groups: surfactant administered ≤ 12 h of life and >12 h and evolution is compared using univariate analysis.

Setting

Neonatal Intensive Care Unit (NICU) level III of a Universitary Hospital.

Patients or participants

57 patients, 30 in the early group and 27 in the late group. Inclusion criteria: neonates from 34⁺⁰ to 36⁺⁶ weeks of gestation, with respiratory distress syndrome, in need of non-invasive ventilation and surfactant.

Interventions

None.

Main variables of interest

Sociodemographic, clinical and evolutionary: redosing, duration of respiratory support, oxygen and time to stop requiring it after surfactant. Also, complications and length of hospitalization.

Results

In the early group there was less need for redosing (3.3% vs 48.1%, P < .001) and a decrease in duration, in days, of stay in the NICU (7 vs 10.5, P .002), invasive mechanical ventilation (2.4 vs 3.9, P .034), total respiratory support (4.6 vs 6.6, P .005) and oxygen therapy (0.4 vs 2.8, P < .001). Also, lower incidence of pneumothorax (0% vs 33.3%, P .001). Furthermore, 12 h after administration, 83.4% maintained FiO2 0.21, compared to 44.4% in the late administration.

Conclusions

In our study, early administration in late preterm infants provides benefits in terms of respiratory assistance and complications. We suggest expanding studies to establish recommendations in this group of patients.