The Clinical Outcome Of Premature Infants With RDS Treated With Different Doses And Time Of Curosurf

[Background]Neonatal respiratory distress syndrome(NRDS) is one of the common diseases in premature infants.There are lots of clinical evidences showing that effective treatment of NRDS can significantly reduce the mortality and improve the prognosis of premature infants.Recent years,pulmonary surfactant(PS) replacement therapy has become a standard medical practice for NRDS in China.However,there are few studies focusing on the outcome of NRDS treated with different doses or time of PS.[Objective]To compare the clinical outcome of premature infants with RDS treated with different doses and time of Curosurf(?).[Methods]1.We retrospectively studied 69 cases of preterm infants,with gestational age of 32 weeks or less and birth weight of 1500g or less,who received Curosurf(?) therapy between Jan 2004 and Mar 2008.2.Grouping:According to the dose of Curosurf(?),the patients were divided into large dose group(200 mg/kg/dose,ranging from 160 to 220mg/kg/dose ) and small dose group (100 mg/kg/dose,ranging from 80 to 120mg/kg/dose ).The patients were also divided into early treatment group(Curosurf(?) administered within 2 hours after birth) and late treatment group(Curosurf(?) administered at 2 hours or later after birth).3.Comparison contents:The clinical symptoms and signs,respiratory support or mechanical ventilation parameters(including FiO₂,PEEP,PIP) were compared before and one hour after treatment.The duration of oxygen supplementation,clinical signs of respiratory distress,the use of assisted ventilation,the ratio of mechanical ventilation,the incidence of chronic lung disease,pulmonary haemorrhage,patent ductus arteriosus, intraventricular hemorrhage,the length of hospital stay,and neonatal mortality were compared between different groups.4.Statistical management:Data were statistically analyzed with SPSS10.0 for windows.T-test and Mann-Whitney test were used for analysis of continuous data, and x² test were used for analysis of categorical data.[Results]1.In all groups,clinical symptoms and signs improved obviously,and FiO₂ were reduced significantly after Curosurf(?) treatment(P＜0.05).2.The FiO₂ required in the high-dose group decreased more obviously than that in the low-dose group(23.36±4.34%vs 27.75±9.49%),but without statistical significance(P＞0.05).In the high-dose group,the duration of assisted ventilation was shorter than that in the low-dose group(36.29±49.89 vs 47.26±34.59h,P=0.06),but the PIP,PEEP,and ratio of mechanical ventilation were similar(17.50±1.61 cmH₂O vs 19.29±4.92 cmH₂O,4.89±0.58 vs 4.62±0.76 cmH₂O,and 27.2%vs 19.4% respectively,P＞0.05).The duration of oxygen supplementation and respiratory distress in the high-dose group seemed shorter than that in low-dose group(30.19±65.04 vs 39.58±55.11 h and 42.03±65.84 vs 76.43±121.86 respectively),but no statistical significance was found(P＞0.05).There are no statistically significant difference between two groups in the incidence of chronic lung disease,pulmonary haemorrhage,patent ductus arteriosus,intraventricular hemorrhage,length of hospital stay,and neonatal mortality(P＞0.05).3.The duration of assisted ventilation and oxygen supplementation in the early treatment group were significantly shorter than that in the late treatment group(38.05±39.58h vs 60.65±37.52,and 35.92±63.22h vs 45.88±49.86h respectively,P＜0.05), but the FiO₂ required after PS administered and the ratio of mechanical ventilation were similar(24.63±8.47%vs 26.41±7.74%,and 28.8%vs 11.8%respectively,P＞0.05).There were no significant differences between two groups in the duration of respiratory distress,the incidence of pulmonary haemorrhage,chronic lung disease,patent ductus arteriosus,intraventricular hemorrhage,the length of hospital stay,and neonatal mortality(P＞0.05).[Conclusions]1.Curosurf(?) can significantly improve the clinical symptoms and signs of NRDS, and reduce the oxygen requirement.2.Large dose of Curosurf(?) tends to shorten the duration of assisted ventilation.3.Eraly use of Curosurf(?) can decrease the length of assisted ventilation and oxygen supplementation.