Who Needs a Second Dose of Exogenous Surfactant?

Lucia Lanciotti; Matteo Pasqualini; Alessio Correani; Ilaria Burattini; Chiara Giorgetti; Maria Laura Palazzi; Paola Cogo; Virgilio Carnielli

doi:10.1016/j.jpeds.2023.113535

Who Needs a Second Dose of Exogenous Surfactant?

J Pediatr. 2023 Oct:261:113535. doi: 10.1016/j.jpeds.2023.113535. Epub 2023 Jun 2.

Authors

Lucia Lanciotti¹, Matteo Pasqualini², Alessio Correani³, Ilaria Burattini⁴, Chiara Giorgetti⁴, Maria Laura Palazzi⁴, Paola Cogo⁵, Virgilio Carnielli³

Affiliations

¹ Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, AN, Italy; Division of Neonatology, Mother and Child Department, G. Salesi University Hospital, Ospedali Riuniti, Ancona, AN, Italy. Electronic address: l.lanciotti@pm.univpm.it.
² Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, AN, Italy.
³ Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, AN, Italy; Division of Neonatology, Mother and Child Department, G. Salesi University Hospital, Ospedali Riuniti, Ancona, AN, Italy.
⁴ Division of Neonatology, Mother and Child Department, G. Salesi University Hospital, Ospedali Riuniti, Ancona, AN, Italy.
⁵ Division of Pediatrics, Department of Medicine (DAME), S. Maria Della Misericordia University Hospital, University of Udine, Udine, Italy.

PMID: 37271494
DOI: 10.1016/j.jpeds.2023.113535

Abstract

Objective: To identify prenatal and postnatal risk factors associated with surfactant redosing.

Study design: Retrospective, single-regional center study including all infants born from 24 + 0 to 31 + 6 weeks of gestation in the Marche Region, Italy, and admitted to a single level III regional NICU from January 1, 2004, to February 28, 2021. Clinical factors associated with surfactant redosing were identified through logistic regression analysis.

Results: Of 1615 consecutive admissions, 662 infants were treated with exogenous surfactant: 462 (70%) received a single dose and 200 (30%) received more than 1 dose (25.5% two doses and 4.5% three doses). Risk of redosing was higher for infants born to mothers with hypertension in pregnancy (OR 3.95, P < .001), for small for gestational age (SGA) infants (OR 3.93, P < .001) and when the first surfactant dose was 100 mg/kg instead of 200 mg/kg (OR 4.56/4.61, P < .001). Infants with greater GA, delayed first surfactant administration, and milder respiratory distress syndrome had reduced risk of redosing. Infants who required multiple surfactant doses had a higher rate of bronchopulmonary dysplasia and mortality, as well as longer duration of respiratory support than patients that received 1 dose.

Conclusions: Hypertension in pregnancy and SGA status were found to be statistically and clinically significant predictors of surfactant redosing. Understanding the pathophysiology of these conditions requires further investigation.

Keywords: hypertension in pregnancy; preterm infants; respiratory distress syndrome; small for gestational age.

MeSH terms

Bronchopulmonary Dysplasia* / drug therapy
Female
Humans
Hypertension* / drug therapy
Infant
Infant, Newborn
Lipoproteins
Pregnancy
Pulmonary Surfactants* / therapeutic use
Respiratory Distress Syndrome, Newborn* / drug therapy
Retrospective Studies
Surface-Active Agents / therapeutic use

Substances

Surface-Active Agents
Pulmonary Surfactants
Lipoproteins