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.