Seven randomized controlled trials comparing prophylactic administration of natural surfactant extract to natural surfactant extract treatment of established Respiratory Distress Syndrome (RDS) have been reported. These 7 trials enrolled 2455 infants. Six of the studies enrolled infants less than 30 weeks gestation exclusively; one study enrolled infants 29-32 weeks gestation. Infants were given either prophylactic surfactant at birth or surfactant treatment if assisted ventilation was required and parenchymal lung disease was noted. Infants who received prophylactic surfactant were treated within 10 minutes of birth. The average time of treatment in the selective treatment group varied from 1.5 to greater than 6 hours. The results of the meta-analysis are given below: Table Prophylactic administration of surfactant leads to a decreased risk of pneumothorax and mortality. No differences in the risk of other neonatal complications are noted. Improved identification of high risk infants could lead to even greater efficacy of prophylactic therapy. Cochrane Neonatal Review Group sponsored by NIH Contract NO1-6-3252.

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