Effect of surfactant administration in respiratory distress syndrome in terms of radiological changes in preterm infants: a multi-center study

Abstract

Objective: To evaluate the immediate clinical and radiological outcomes of surfactant administration in preterm newborns with respiratory distress syndrome.

Method: The multicentre cohort study was conducted from January to August 2024 at the Pakistan Railway Hospital/Islamic International Medical College, and Khan Research Laboratories Hospital, Islamabad, Pakistan, and comprised preterm newborns diagnosed with of respiratory distress syndrome who had been planned to receive surfactant therapy. Neonatal demographical and clinical characteristics were recorded along with the technique of surfactant administration. Post-surfactant management, the need for mechanical ventilation and chest X-ray findings were evaluated. Data was analysed using SPSS 26.

Results: Of the 84 newborns, 64(76.2%) were boys. The overall mean birthweight was 1.86±0.76kg. The most frequent post-treatment complications were pneumothorax 19(22.6%), hypotension 6(7.1%) and pulmonary haemorrhage 4(4.8%). Mechanical ventilation was required in 81(96.4%) cases. The median duration of intensive care was 9.24±6.41 days. Pulmonary haemorrhage (p=0.024), hypotension (p=0.005), post-treatment arterial blood gas potential of hydrogen (p=0.024), and duration of stay under intensive care (p=0.009) were significantly associated with mortality. Post-treatment chest X-ray staging showed significant improvement in infants receiving surfactant therapy (p<0.001). Binary logistic regression identified low birthweight (p=0.005) and cyanosis (p=0.006) at the time of presentation as independent predictors of mortality.

Conclusion: There were significant clinical and radiological benefits of surfactant therapy in preterm newborns with respiratory distress syndrome.

Key Words: Low birthweight, Mechanical ventilation, Pneumothorax, Pulmonary haemorrhage, Respiratory distress syndrome, Surfactant.