Surfactant Replacement Therapy in Preterm Infants: a European Survey

Background: Exogenous surfactant is an undisputed treatment for neonatal respiratory distress syndrome but its efficacy is highly dependent on the treatment strategy. International guidelines have published recommendations on the optimal surfactant replacement strategy.

Objective: To determine how evidence-based guidelines on surfactant replacement therapy are implemented in daily clinical practice.

Methods: Data on surfactant replacement therapy, including preparation, dosing and timing, were collected in 173 European neonatal intensive care units (NICUs) by questionnaire and in a cohort of preterm infants mechanically ventilated on two separate predefined dates in these units.

Results: All NICUs used animal-derived surfactant in the treatment of respiratory distress syndrome, with Poractant being most widely used (86%). The most frequently used first dose was 100 mg/kg (58%) and 200 mg/kg (39%) and all NICUs allowed for repeat dosing. 39% of the NICUs claimed to use prophylactic treatment (<15 min of life). Data on surfactant treatment were collected in 338 infants, with a median gestational age of 27 weeks and a birth weight of 860 g. All infants were treated with animal-derived surfactant. The median first dose was 168 mg/kg in the Poractant group compared with 100 mg/kg in the Beractant and Bovactant groups. Prophylactic treatment was used in 23% of the infants and 28% of the infants received surfactant >2 h after birth. 43% of the infants received multiple doses.

Conclusions: With the exception of surfactant timing, guidelines on surfactant replacement therapy seem to be implemented in daily clinical practice in European NICUs.