Compare severity of Bronchopulmonary Dysplasia in Neonates with Respiratory Distress Syndrome Treated with Surfactant to without Surfactant
Uraiwan Chotigeat MD*, Sombat Ratchatanorravut MD**, Wiboon Kanjanapattanakul MD*
Affiliation : * Division of Neonatology, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, Thailand ** Department of Pediatrics, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, Thailand
Background : The utilization of surfactant replacement therapy had been limited in treatment of respiratory distress syndrome
(RDS) due to the high cost especially in developing countries. Nowadays, the National Health Insurance Policy has covered
the cost of surfactant for the patients. Therefore, bronchopulmonary dysplasia (BPD) may be found increasing due to
increased survival in patients with severe RDS.
Objective : To compare immediate treatment outcome of severity of BPD and outcome after hospital discharge in neonates
with RDS who were treated with or without surfactant.
Study design : Retrospective cohort study.
Material and Method: The data of 54 infants who developed BPD after RDS at Queen Sirikit National Institute of Child
Health between January 1st, 2003 and December 31th, 2005 were kept in database format. The database was analyzed for
difference between groups and the outcome of immediate treatment, severity of BPD and outcome after hospital discharge
were compared. The study group was BPD cases from RDS treated with surfactant compared to control (BPD cases from
RDS treated without surfactant) groups.
Results : Forty-three (80%) from fifty-four cases had completed data and were included into the present study. There was no
statistically significant difference in maternal conditions and neonatal conditions between groups. Antenatal steroid was
prescribed more often in RDS without surfactant group than surfactant group. The mean birth weight and gestational age in
surfactant and without surfactant groups were 1,179.1 + 274.3 gm vs. 1,114.4 + 338.3 gm and 29 + 1.6 weeks vs. 29.2 + 2.7
weeks respectively, but no significant differences were observed between groups. To compare the severity of RDS, only 17.6%
of moderate to severe RDS in the control group was found, whereas 100% was found in the study group. Moderate to severe
BPD cases were found more often in the control group (70.6%) than in the study group (61.6%), but no statistically significant
difference was shown. The immediate complications, e.g. pneumothorax (5.9%) and pneumomediastinum (5.9%) were found
in the control group, but pulmonary hemorrhage occurred more often in the study group than the control group (11.5% vs.
5.9%). For long-term follow-up, the development outcome was not different between groups.
Conclusion : The present study revealed no statistically significant difference in severity of BPD in neonates with RDS treated
with and without surfactant groups. In addition, surfactant was useful in moderate to severe RDS because no early complication
such as air leak syndrome was found in this group.
Keywords : RDS, BPD, Surfactant
