Exogenous surfactant in the neonate suggestions for the use in the developing countries

Künye

Exogenous surfactant in the neonate suggestions for the use in the developing countries. Perinatoloji Dergisi 2002;10(3):158-158

Yazar Bilgileri

Giulio Bevilacque

University of Parma - IT

Yazışma Adresi

Giulio Bevilacque, University of Parma - IT,

Yayın Geçmişi

Çıkar Çakışması

Çıkar çakışması bulunmadığı belirtilmiştir.

In spite of the improvement of perinatal assistance, the frequency of the Respiratory Distress Syndrome of preterm babies (NRDS) remains very high. The estimated incidence of NKDS in babies with a birth weight 500- 750. (very low birth weight -VLBW) reaches the value of 86%.
In the last ten years survival of babies with NRDS, significantly improved with introduction of new techniques of prevention and of treatment of the disease, mainly with the diffusion of the use of the exogenous surfactant.
The exogenous surfactant administration in VLBW, either as prophylaxis or as rescue treatment of NRDS, is effective in reducing mortality, morbidity and need for respiratory supports. No adverse effects related to surfactant administration have been reported. However there is great variability in the use of the surfactant treatment, within and between countries in Europe and out of Europe, related not only to a different medical strategies and organisations, but also to the costs. The surfactant preparations currently on market are relatively expensive and their supply relatively limited. We must remember, also, that to achieve good results, the supplementaıy surfaclant must be given by qualified physicians trained in neonatal intensive çare and in management of mechanical ventilation of preterm babies.
Supplementary surfactant should be used routinely, only, in neonatal intensive care units having the necessary facilities for mechanical ventilation and resuscitation of VLBW infants. For all these reasons, in the developing countries it is necessaıy to identify strategies compatible with the health organisation of the country considered.
At the moment, any scheme for prevention and treatment of NRDS, should include the prenatal prophylaxis, with a single course of corticosteroids, given to the mothers at risk of preterm delivery before 34-wk. gestational age (ge). Repeated courses of corticosteroids must be used cautiously, because they may have lasting negative side effects on foetal growth and neurological development, whereas clear bene-fits for the foetus have not yet been shown. After birth exogenous surfactant might be use as prophylaxis or as rescue treatment. In new-borns with ge, 26-28 wk. and with evidence of high risk for NRDS (male sex, perinatal asphyxia, need of intubation at birth, incomplete course of antenatal corticosteroids, caesarean section, mulliple pregnancies, maternal diabeles) the early administration, in the first minutes of life, of a single low dose of surfactant improves the outcomes and results more effective then delayed treatment and therefore it is recommended.

In the spontaneously breathing babies, continuous positive airway pressure (CPAP), after a brief intubation, might be useful to avoid mechanical ventilation. In the new-borns, with gestational age > 28 weeks with NRDS, treatment may be delayed, to reduce the number of unnecessary administrations and reserved to the babies that need intermittent positive pressure ventilation (IFPV). In that cases the full dosage of the available surfactant is mandatory. In extremely low gestational age new-borns (<26 wk.) the surfactant administration must be evaluated case by case and discussed with the parents because of poor outcomes of these babies.