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Surfactant Therapy for Neonatal Respiratory Distress Syndrome : Experience in Korea Over 15 Years

Korean Journal of Pediatrics 2004;47(9):940-948.
Published online September 15, 2004.
Surfactant Therapy for Neonatal Respiratory Distress Syndrome : Experience in Korea Over 15 Years
Chong-Woo Bae, Young-Min Kim
Department of Pediatrics, College of Medicine, Kyunghee University, Seoul, Korea
신생아 호흡곤란 증후군에서 인공 폐 표면활성제 보충요법 제 3 보고 : 지난 15년간 한국에서의 치료 결과
배종우, 김영민
경희대학교 의과대학 소아과학교실
Correspondence: 
Chong-Woo Bae, Email: baecwkmc@zaigen.co.kr
Abstract
Purpose
: Surfactant replacement therapy in neonates with respiratory distress syndrome(RDS) has been used in Korea since 1990. We undertook a collective study of trials from multi-hospitals to evaluate results of neonates with RDS who were treated with surfactant during the past 15 years in Korea(Period I, P-I, 1990-91; Period II, P-II, 1996; Period-III, P-III; 2002).
Methods
: There were 60 neonates in P-I(16 hospitals), 1,179 in P-II(64 hospitals), 1,581 in P-III(62 hospitals). Initial chest radiological findings were classified by Bomsel's criteria. The severities of RDS were categorized by ventilatory index(VI), and types of responses after surfactant therapy were classified by changes in VI, FiO2 and a/APO2 as good, relapse and poor.
Results
: We used Surfacten(Japan) on P-I, Surfacten and Exosurf(USA) in P-II, and Surfacten and Newfactan(Korea) in P-III. Most of the cases were treated by single dose in P-I, II, however in P-III, 79.9% of the cases were treated with a single dose and 20.1% with multiple-dose therapy. According to the initial chest radiological findings, stage III or IV were 82% in P-I, 64% in P-II, 67.7% in P-III, respectively. According to the initial severities, mild RDS were 25.5%, moderate RDS were 44.8% and severe RDS were 29.7%, respectively in P-III. The proportion of infants with initial good responses were higher in P-II, III than P-I(58.3% vs 71.7%, 68.4%). The incidence of complications and associated diseases were similar during the three periods. The mortality rate was significantly decreased in P-III than P-I, II(40.0%, 30.0% vs 18.7%), respectively.
Conclusion
: We concluded that surfactant treatment in neonates with RDS has had an impact on improving clinical courses and outcome. The mortality rate in RDS was significantly decreased during the last 15 years in Korea.
Key Words: Respiratory distress syndrome, Newborn, Prematurity, Surfactant, Pulmonary surfactant, Outcome, Collective study


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