Abstract
Background: Exogenous surfactant (S) therapy improved mortality and morbidity of premature babies with respiratory distress syndrome. The commercial S preparation used in our NICU is natural “bovine” type. The adverse effects of this therapy have not been clarified yet.
Objective: To estimate the early and later risks of S therapy for respiratory distress syndrome (RDS).
Methods: Data from all premature newborns with or without RDS treated or not with S in our NICU the last 10 years were analyzed. The incidence and the relative risk(RR) of the lung and intracerebral hemorrhage as well as of the infection were calculated. Three hundred ninenty three of them accepted to participate in a retrospective study and were examined for allergic disorders, such as allergic rhinitis, asthma and adverse food reactions.
Results: Three thousands forty premature newborns graduated our NICU from 1994 to 2004.Pulmonary hemorrhage was observed in the 57 of the 330 newborns with RDS who received S and the 6 over 198 of those newborns untreated with S,chi squared= 19.489, p= 0.00001,RR= 5.756. Intraventricular hemorrhage was diagnosed in 106 of the 281 and 20 over 184, respectively, chi square = 24.629, p= 0.00001,RR= 3.490.Infection in 115 of 272 and 87 in 117,respectively, chi squared = 9.291,p= 0.00167,RR= 1.768. Positive history of allergy was estimated in the 44% of the children treated with S for RDS and in the 25% of those with RDS not treated with S, chi squared= 11.363, p= 0.000749.From the premature babies without RDS allergy was noted in 28%,x= 0.8061,p= 0.3692.
Conclusion: Despite the undoubtfull benefits of the S therapy for RDS attention should be paid to its possible early and late adverse effects. The S therapy increases the risk for severe even lethal complications such as pulmonary or intraventricular hemorrhage and infection. It is impressive the almost two-fold increase in the incidence of allergy during childhood in babies treated with S compared to non-treated ones. Prospective clinical trials and basic research would help to minimize the early risks and optimize late prognosis in newborns treated with S.
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Ikonomou, P., Pavlou, V., Nila, X. et al. 117 Early and Late Adverse Effects Following Surfactant Therapy. Pediatr Res 56, 484 (2004). https://doi.org/10.1203/00006450-200409000-00140
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DOI: https://doi.org/10.1203/00006450-200409000-00140
