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Characteristics and outcomes of preterm neonates according to number of doses of surfactant received

Journal of Perinatology volume 41, pages 39–46 (2021)Cite this article

Subjects

Abstract

Objectives

To identify characteristics and outcomes of infants who received multiple doses of surfactant vs those who received one dose or none.

Study design

In this retrospective study, we included neonates of 22–28 weeks’ gestation admitted to NICUs in the Canadian Neonatal Network. Patients were divided into three groups: no surfactant, single dose, and multiple doses. The primary outcome was a composite of mortality or any of the major morbidities, including severe neurological injury, bronchopulmonary dysplasia, or ≥stage 3 retinopathy of prematurity.

Results

Of 8024 eligible neonates, 2461 (31%) did not receive surfactant, 3545 (44%) received one dose, and 2018 (25%) received >1 dose. Receiving one or more doses of surfactant was associated with significantly higher adjusted odds of mortality or major morbidities in a dose-dependent manner.

Conclusions

Receiving one or more doses of surfactant was associated with adverse neonatal outcomes. Receipt of more than one dose may reflect underlying severe lung immaturity.

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Fig. 1: Multivariable analyses: adjusted odds ratios (95% CI).
Fig. 2: Subgroup analyses for 2 gestational age groups: adjusted odds ratios (95% CI).

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Data availability

The data sets generated and analyzed during the current study are with the corresponding author but current data transfer approval agreements do not allow for data to be made available to others.

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Acknowledgements

The authors thank all site investigators and data abstractors of the CNN and the Canadian Preterm Birth Network (CPTBN). A full list of Network member investigators and their affiliations appears in Supplementary Information. We thank Heather McDonald Kinkaid, PhD, of the Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, ON, Canada, for editorial support in preparing this manuscript; and other MiCare staff, for organizational support.

Funding

This study was supported by a grant from the Canadian Institutes of Health Research (CIHR) funding the Canadian Preterm Birth Network (PBN 150642). Organizational support for the CNN and the Canadian Preterm Birth Network was provided by the Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, ON, Canada. MiCare is supported by a CIHR Team Grant (CTP 87518), the Ontario Ministry of Health and Long-Term Care, and the participating hospitals. PSS holds a CIHR Applied Research Chair in Reproductive and Child Health Services and Policy Research (APR-126340).

Author information

Authors and Affiliations

  1. Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada

    Hanita Coshal, Eugene W. Yoon & Prakesh S. Shah

  2. Department of Pediatrics, McMaster Children’s Hospital, Hamilton, ON, Canada

    Amit Mukerji

  3. Division of Neonatology, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    Brigitte Lemyre

  4. Division of Neonatology, The Ottawa Hospital, Ottawa, ON, Canada

    Brigitte Lemyre

  5. Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Eugene H. Ng

  6. Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada

    Ruben Alvaro

  7. Department of Nursing, CHU Sainte-Justine, Montreal, QC, Canada

    Guillaume Ethier

  8. Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada

    Marc Beltempo

  9. Department of Pediatrics, Montreal Children’s Hospital, Montreal, QC, Canada

    Marc Beltempo

  10. Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada

    Prakesh S. Shah

  11. Department of Pediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Prakesh S. Shah

Authors
  1. Hanita Coshal
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  2. Amit Mukerji
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  3. Brigitte Lemyre
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  4. Eugene H. Ng
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  5. Ruben Alvaro
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  6. Guillaume Ethier
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  7. Eugene W. Yoon
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  8. Marc Beltempo
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  9. Prakesh S. Shah
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Contributions

HC and PSS conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. AM, BL, EHN, RA, GE, and MB participated in study design and data interpretation and reviewed and revised the manuscript. EWY analyzed the data and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work in ensuring that questions related to its accuracy or integrity are appropriately investigated and resolved.

Corresponding author

Correspondence to Prakesh S. Shah.

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The authors declare that they have no conflict of interest.

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Coshal, H., Mukerji, A., Lemyre, B. et al. Characteristics and outcomes of preterm neonates according to number of doses of surfactant received. J Perinatol 41, 39–46 (2021). https://doi.org/10.1038/s41372-020-00779-9

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