Evaluation of the effects of surfactant replacement therapy in neonatal respiratory distress syndrome.

OBJECTIVE: Respiratory distress syndrome (RDS) is a major cause of morbidity and mortality in preterm neonates. Pulmonary surfactant deficiency is the primary cause of RDS. The purpose of this study was to determine the effect of surfactant therapy in reduction of the mortality rate in premature neonates with RDS and to assess the relationship between the efficacy of surfactant therapy and some risk factors associated with RDS.

METHODS: This study comprised 89 premature neonates with signs of RDS. The neonates were selected by simple sampling from those admitted to the Neonatal Intensive Care Unit (NICU) of Shaheed Beheshti Hospital. The eligible neonates received surfactant replacement-therapy (100 mg/kg) during 48 hours after birth.

RESULTS: Overall, 34 (38.2%) out of 89 neonates who received surfactant survived. The higher efficacy of surfactant replacement therapy was observed in neonates with gestational age of more than 32 weeks (47.5%), in those who received the first dose of surfactant during the first 24 hours of life (43.3%), in those with an Apgar score of more than 7/10 at 1 and 5 min (48.1%), and in those with a birth weight of more than 1 500 g (52.5%). The neonates whose mother received steroid therapy before labor had higher reduction in mortality after surfactant therapy (41.7% with steroid vs 34.2% without steroid; p<0.05).

CONCLUSIONS: Surfactant replacement therapy in neonatal RDS should be started as soon as possible after birth. It could reduce the mortality rate from RDS by 38.2%. The efficacy of surfactant therapy for neonatal RDS may be associated with gestational age, Apgar score, birth weight, starting time of surfactant therapy and maternal steroid therapy.