Outcomes Comparison of Early versus Late Surfactant Replacement Therapy in Neonates with Respiratory Distress Syndrome

Objective: To compare durations of invasive mechanical ventilator (IMV), other types of ventilator support and neonatal outcomes between neonates who received early versus late surfactant replacement therapy (E-SRT vs. L-SRT). Materials and Methods: This retrospective study included neonates with gestational age (GA) less than 35 weeks or birth weight (BW) less than 2,000 grams, born between January 1, 2017 to December 31, 2021. Neonates who received SRT before 2 hours of life were defined as E-SRT and neonates who received SRT later were defined as L-SRT. Durations of IMV, other types of ventilator support, neonatal outcomes and length of stays were documented. Results: Eighty-three neonates had received SRT with 52 (62.7%) had E-SRT and 31 (37.3%) had L-SRT. Neonates in E-SRT group had significantly lower GA and BW than neonates in L-SRT group (median GA 27 vs. 30 weeks; p = 0.002 and median BW 885 vs. 1330 grams; p = 0.003) and had longer duration of IMV but not significant (median 19.0 vs. 10.5 days; p = 0.219). There were no significant differences in durations of other types of ventilator support. After adjusted for sex, GA and BW, there were no significant differences in neonatal outcomes between neonates in each group. Ventilator-associated pneumonia (VAP) and septicemia were independent factors associated with prolonged IMV, ventilator supports and length of stays. Conclusion: Timing of SRT was not associated with duration of IMV. VAP and septicemia were important factors prolonging ventilator durations and length of stays and should be prevented.Keywords: surfactant replacement therapy, respiratory distress syndrome, timing of surfactant, neonatal outcomes