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Neurodevelopmental outcome and pulmonary morbidity two years after early versus late surfactant treatment: does it really differ?


R Hentschel, Department of Pediatrics and Adolescent Medicine, University Hospital Freiburg, Mathildenstr. 1, 79106 Freiburg, Germany.
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Aim: To investigate whether neurodevelopmental outcome or pulmonary morbidity at age two years might be different after early versus late surfactant treatment in intubated preterm infants with severe respiratory distress syndrome (RDS).

Methods: In 185 ex-preterm infants of 27–32 completed weeks of gestation, who were enrolled in a controlled trial of early versus late surfactant treatment (31 ± 19 min vs. 202 ± 80 min, respectively), a standardized follow up of medical history, pulmonary morbidity and neurodevelopmental outcome using the Griffiths scales were carried out.

Results: Neurobehavioural and motor development was comparable in both groups, as was medical history and actual morbidity. However, in the early treatment group a delay in the subscale ‘personal social’ of the Griffiths test and in one ‘milestone’ of motor development (rolling over from supine to prone) was noticed, and the rate of increased muscular tone was significantly higher.

Conclusion: In terms of long-term morbidity or neurological development there is no obvious advantage of an immediate surfactant administration after intubation in preterm infants with RDS. This is in line with our results published earlier on morbidity at discharge, so improvement of gas exchange after intubation can first be awaited before surfactant is indicated.