Effects of surfactant treatment on pulmonary outcome of near-term infants undergoing non invasive ventilation for idiopathic respiratory distress syndrome

Objective: To assess pulmonary outcomes for near term infants undergoing nasalflow synchronized intermittent positive pressure ventilation (NFSIPPV) for IRDSand receiving surfactant treatment by brief intubation and extubation (INSURE)based on two different inspired oxygen (FiO2) threasholds (FiO2 = 0.60 vs FiO2= 0.80).Study design: Prospective randomized controlled study in infants with GA ≥34wks and BW ≥1500 g, who developed IRDS after elective cesarean section andrequired FiO2 of 0.60.Results: 40 infants were randomized to receive surfactant at FiO2 of 0.60 or 0.80.All of the infants (20/20) randomized to receive the INSURE protocol at FiO2=0.60were treated with surfactant, whereas only 8/20 randomized to receive INSURE atthe higher FiO2 developed IRDS severe enough (FiO2= 0.80) to be treated withsurfactant. There were no significant differences between two treatment groups(higher vs lower FiO2 threashold) in demographic and clinical characteristics priorto randomization, in the percentage of infants requiring mechanical ventilation(33% vs 20%, p=0.596), in the incidence of air leaks, duration of mechanicalventilation, duration of oxygen requirement, or duration of the hospital stay; however, the median number (quartiles) of surfactant doses per infant was significantlylower in infants who received INSURE at the higher FiO2 [0 (0 - 1 vs 1 (1 - 1)),p<0.001].Conclusions: For infants treated with NFSIPPV for IRDS, INSURE performed ata higher FiO2 threshold is as safe and beneficial as treatment performed at a loweroxygen threshold, and is associated with a reduced requirement for surfactant