Surfactant Replacement Therapy in Neonates with Respiratory Distress Syndrome: A Collective Evaluation of Trials from 16 Hospitals

Bae, CW; Kwon, YD; Ko, SJ; Kim, KS; Kim, HM; Park, WS; Byun, SH; Son, CS; Ahn, HS; Lee, SG; Chang, YP; Chung, YJ; Cho, KS; Cho, KH; Choeh, KC; Chey, MJ; Choi, JH; Yoon, JK; Ahn, CI; Chida, S; Fujiwara, T

Original Article

Journal of the Korean Pediatric Society 1993;36(2):244-265.
Published online February 15, 1993.

Surfactant Replacement Therapy in Neonates with Respiratory Distress Syndrome: A Collective Evaluation of Trials from 16 Hospitals

CW Bae¹, YD Kwon², SJ Ko³, KS Kim⁴, HM Kim⁵, WS Park⁶, SH Byun⁷, CS Son⁸, HS Ahn⁹, SG Lee¹⁰, YP Chang¹¹, YJ Chung¹², KS Cho¹³, KH Cho¹⁴, KC Choeh¹⁵, MJ Chey¹⁶, JH Choi¹¹, JK Yoon¹¹, CI Ahn¹, S Chida¹⁷, T Fujiwara¹⁷

¹Kyunghee University, Hosp, Seoul
²Taegu Catholi hosp., Taegu
³Sowha Children`s Hosp., Seoul
⁴Seoul Chungang Hosp, Seoul
⁵Kyungpook National Univ. Hosp, Seoul
⁶Cha Women`s Hosp, Seoul
⁷Chungnam National Univ. Hosp, Daejeon
⁸Korea Univ. Hosp., Seoul
⁹Sungbundo Hosp., Pusan
¹⁰Taegu Fatima Hosp., Taegu
¹¹Seoul National Univ. Hosp., Seoul
¹²Kosin Medical Center, Pusan
¹³Marynoll Hosp., Pusan
¹⁴Catholic Medical Univ., ST. Vincent Hosp., Suwon
¹⁵Eulji General, Hosp, Seoul
¹⁶Gil General, Hosp., Inchon
¹⁷Iwate Medical Univ., Morioka, Japan

신생아 RDS에서 인공 폐 Surfactant 보충요법:한국 다기관의 초기성적 및 사망관련인자의 분석

배종우^¹^, 권영대^²^, 고세중^³^, 김기수^⁴^, 김행미^⁵^, 박원순^⁶^, 변상현^⁷^, 손창성^⁸^, 안호식^⁹^, 이상길^¹⁰^, 장영표^¹¹^, 정윤주^¹²^, 조경숙^¹³^, 조규홍^¹⁴^, 최규철^¹⁵^, 최명재^¹⁶^, 최중환^¹¹^, 윤종구^¹¹^, 안창일^¹^, 千田勝一^¹⁷^, 藤原哲郞^¹⁷

^¹경희의대 소아과
^²대구 가톨릭병원 소아과
^³소화아동병원 소아과
^⁴서울 중앙병원 소아과
^⁵경북의대 소아과
^⁶차병원 소아과
^⁷충남의대 소아과
^⁸고려의대 소아과
^⁹부산 성분도병원 소아과
^¹⁰대구 파티마병원 소아과
^¹¹서울의대 소아과
^¹²고신의대 소아과
^¹³부산 메리놀병원 소아과
^¹⁴가톨릭의대 성빈센트 소아과
^¹⁵대전 을지병원 소아과
^¹⁶인천 중앙 길병원 소아과
^¹⁷日本岩手醫科大學小兒科

Abstract

Surfactant replacement therapy in neonates with respiratory distress syndrome (RDS) has been introduced in our country since May 1990. The purpose of this study was to assess the effect and short-term outcome of surfactant replacement for neonatal RDS using collective data of uncontrolled trials from different hospitals in Korea. For the period May 1990 to Dec. 1991, a total of 68 RDS neonates were treated with a reconstituted bovine surfactant (Surfactant-TA) at 17 hospitals. Data on 60 neonates were collected from 16 hospitals and were analyzed in this study. In order to examine the factors that might influence the mortality, we performed a stepwise discriminant analysis. RDS was diagnosed according to accepted clinical and radiographic criteria at each hospital. The mean gestational age of 60 neonates was 31¡¾3 weeks (1 SD, range, 24~40 wk) and the mean birth improvement in ventilatory requirement during the subsequent clinical course. However, there were respirator settings after surfactant treatment. The neonatal mortality was 40% in this group. When improvement was significantly less in death group than that in survival group. Factors affecting the neonatal mortality include a poor response to surfactant, sepsis and/or DIC, decreasing gestational age and birth weight, acidosis before treatment and air-leaks. We conclude that treatment with Surfactant-TA has an impact on the clinical course of RDS. To optimize the effects of surfactant therapy, the following refinement will be needed: better initial stabilization with respect to blood pressure, blood gases and pH, instillation techniques including pre-and post-surfactant ventilation, weaning guidelines, dose, dose schedule, as well as timing of treatment, management of infection, and prevention of severe birth asphyxia.

Key Words: Neonatal respiratory distress syndrome, Surfactant replacement, Mortality