Evaluation of varying thresholds of fraction of inspired oxygen on the need for surfactant administration and comorbidities among preterm neonates with respiratory distress syndrome: a prospective cohort study
DOI:
https://doi.org/10.18203/2349-3291.ijcp20260403Keywords:
Preterm, Respiratory distress syndrome, Pulmonary surfactant, Respiratory therapyAbstract
Background: Respiratory distress syndrome (RDS) in preterm neonates results from surfactant deficiency, causing alveolar collapse. Continuous positive airway pressure (CPAP) is the preferred initial support, with surfactant administration based on fraction of inspired oxygen (FiO2) thresholds. However, the optimal FiO2 threshold remains uncertain. To assess surfactant need in preterm neonates on CPAP requiring FiO2 30-40% based on Silverman-Anderson scores and FiO2 trends.
Methods: This prospective cohort study was conducted at SMS Medical College, Jaipur, including preterm neonates (26-34 weeks' gestation) requiring CPAP. Neonates were categorized into three groups: Group A (<30% FiO2), Group B (30-40%), and Group C (>40%). In Group B, surfactant was administered based on FiO2 trends and Silverman–Anderson scores.
Results: Among 96 neonates, 70 (72.9%) received surfactant, while 26 (27.1%) did not. Higher FiO2 and Silverman-Anderson scores at 6 hours were significantly associated with surfactant need (p<0.0001). However, maternal factors (antenatal steroids, mode of delivery, Gravida) showed no significant association with surfactant use.
Conclusions: Neonates requiring FiO2 30-40% on CPAP can often be managed without immediate surfactant administration if their Silverman-Anderson score and FiO2 improve within 6 hours. A FiO2 threshold of 35%, combined with clinical monitoring, may be a more effective criterion for surfactant therapy, reducing unnecessary administration.
Metrics
References
Gulczyńska E, Szczapa T, Hożejowski R, Maria KBK, Magdalena R. Fraction of inspired oxygen as a predictor of CPAP failure in preterm infants with respiratory distress syndrome: A prospective multicenter study. Pediatr Neonatol. 2019;116(2):171-8. DOI: https://doi.org/10.1159/000499674
Kruczek P, Krajewski P, Hożejowski R, Szczapa T. FiO2 Before Surfactant, but Not Time to Surfactant, Affects Outcomes in Infants with Respiratory Distress Syndrome. Front Pediatr. 2018;9:734696. DOI: https://doi.org/10.3389/fped.2021.734696
Patel P, Houck A, Fuentes D. Examining Variations in Surfactant Administration (ENVISION): A Neonatology Insights Pilot Project. Children. 2021;8(4):261. DOI: https://doi.org/10.3390/children8040261
Conlon SM, Osborne A, Bodie J. Introducing Less-Invasive Surfactant Administration into a Level IV NICU: A Quality Improvement Initiative. Children. 2021;8(7):580. DOI: https://doi.org/10.3390/children8070580
Gupta BK, Saha AK, Mukherjee S, Saha B. Minimally invasive surfactant therapy versus InSurE in preterm neonates of 28 to 34 weeks with respiratory distress syndrome on noninvasive positive pressure ventilation-a randomized controlled trial. Eur J Pediatr. 2020;179(8):1287-93. DOI: https://doi.org/10.1007/s00431-020-03682-9
Ng EH, Shah V. Guidelines for surfactant replacement therapy in neonates. Pediatr Clin North Am. 2021;26(1):35-41. DOI: https://doi.org/10.1093/pch/pxaa116
Bruna SP, Vieira SP, Souza TR, Paschoal LN, Magalhães MR, et al. Early CPAP protocol in preterm infants with gestational age between 28 and 32 weeks: experience of a public hospital. BJPT. 2021;25(4):421-7. DOI: https://doi.org/10.1016/j.bjpt.2020.09.001
Yadav S, Lee B, Kamity R. Neonatal Respiratory Distress Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.
Dunn MS, Reilly MC. Approaches to the initial respiratory management of preterm neonates. Paediatr Respir Rev. 2003;4(1):2-8. DOI: https://doi.org/10.1016/S1526-0542(02)00305-6
Owen LS, Morley CJ, Davis PG. Neonatal nasal intermittent positive pressure ventilation: a survey of practice in England. Arch Dis Child Fetal Neonatal Ed. 2008;93(2):F148-50. DOI: https://doi.org/10.1136/adc.2007.118109
Avery Me, Mead J. Surface properties in relation to atelectasis and hyaline membrane disease. AMA J Dis Child. 1959;97(5 Part 1):517-23. DOI: https://doi.org/10.1001/archpedi.1959.02070010519001
Li Y, Wang W, Zhang D. Maternal diabetes mellitus and risk of neonatal respiratory distress syndrome: a meta-analysis. Acta Diabetol. 2019;56(7):729-40. DOI: https://doi.org/10.1007/s00592-019-01327-4
Agarwal R, Deorari A, Paul V, Sankar MJ, Sachdeva A. AIIMS Protocols in Neonatology. New Delhi. CBS Publishers and Distributors. 2019;180.
Roth-Kleiner M, Post M. Similarities and dissimilarities of branching and septation during lung development. 2005;40(2):113 34. DOI: https://doi.org/10.1002/ppul.20252
Reuter S, Moser C and Baack M. Respiratory Distress in the Newborn. 2014;35(10):417-29. DOI: https://doi.org/10.1542/pir.35.10.417
Mahoney AD, Jain L. Respiratory disorders in moderately preterm, late preterm, and early term infants. Clin Perinatol 2013;40:665-78. DOI: https://doi.org/10.1016/j.clp.2013.07.004
Woodworth A, Christopher R. McCudden. Laboratory testing in pregnancy. In book: Contemporary Practice in Clinical Chemistry. 2020;743-58. DOI: https://doi.org/10.1016/B978-0-12-815499-1.00042-9
Roberts D, Dalziel S: Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database SystRev. 2006;(3):CD004454. DOI: https://doi.org/10.1002/14651858.CD004454.pub2
Travers CP, Clark RH, Spitzer AR. Exposure to any antenatal corticosteroids and outcomes in preterm infants by gestational age: Prospective cohort study. BMJ. 2017;356:j1039. DOI: https://doi.org/10.1136/bmj.j1039
Downloads
Published
How to Cite
Issue
Section
