All issues > Volume 33(1); 1990

Original Article

J Korean Pediatr Soc. 1990;33(1):22-34. Published online January 31, 1990.

Exogenous Surfactant Replacement Therapy of Hyaline Membrane Disease: A controlled clinical trial.

Ran Namgung¹, Chul Lee¹, Kook In Park¹, Dong Gwan Han¹

¹Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea

Received: June 22, 1989;  Accepted: October 10, 1989.

Abstract

We conducted a clinical controlled trial of exogenous surfactant replacement therapy in premature infants with hyaline membrane disease at the neonatal intensive care unit of Yonsei University Medical Center form Nov. 1987 to May 1988. Sixteen premature infants with severe HMD were randomly assigned to control group or surfactant-treated group. Eight infants (mean gestational age 29.9±2.8 week, mean birth weight 1, 425±308.9 gm) were given surfactant-TA (a dose of 120 mg/kg) and eight infants (mean gestational age 30.3±1.3 week, mean birth wieight 1,465±201.9gm) received intermittent mandatory ventila- tion only. Significant improvements in oxygenation (less FiO2, increased a/A PO2) and respiratory support (decreased MAP and VI) were seen in the surfactant-treated group within three to six hours after treatment, which maintained during the first five days of treatment. A decrease in the need for respiratory support in the surfactant-treated group was reflected by a fewer number of days in FiO2 > 0.4 and the total days in supplemental oxygen. The percentage of babies who need high oxygen concentrations (FiO2 > 0.6) at the first day of life was significantly lower in the surfactant-treated group (87.5 VS 37.5%). A total days in assisted ventilation and the days to extubation were also shortened in the surfactant-treated group. Extubation rate at the fifth day of treatment was significantly higher in the surfactant-treated group (25 VS 57.1%). PDA occurred more often in the surfactant-treated group (1 VS 4); pneumothorax (3 VS 1) and intraventricular hemorrhage (4 VS 2) occurred less often. More babies in the surfactant-treated group survived (7 VS 6), but the difference was not statisti- cally significant. The chest radiograph scores before treatment showed no significant differences between the two groups (53 VS 48). But after surfactant treatment, significant improvement in the chest radiograph scores was noted in the surfactant-treated group (48 VS 33). We conclude that surfactant-TA, administered early in the course of severe HMD, is an effective therapy that can diminish the need for oxygen and respiratory support during the entire treatment period, and can moderate the course of severe HMD.

Keywords :Exogenous Surfactant Replacement Therapy, HMD of premature infants