RADIOLOGISCHE VERANDERUNGEN NACH SURFACTANTTHERAPIE. ERGBNISSE EINER RANDOMISIERTEN EUROPAISCHEN MULTIZENTERSTUDIE MIT PORCINEM SURFACTANT (CUROSURF)

343 preterm infants treated with either single or multiple doses of the natural surfactant preparation Curosurf had chest X-rays immediately before and 12 hours after initiation of therapy. There were no differences in the baseline characteristics of both treatment groups or radiological disease severity. Before surfactant replacement about 90% of patients showed severe respiratory distress syndrome grade III or IV on their chest-X-ray, 12 hours later only 14% logistic regression analysis showed good correlation of radiological severity of respiratory distress syndrome before therapy with neonatal morbidity and mortality. Patients with initially radiological severity grade IV of respiratory distress syndrome had an increased risk of pulmonary interstitial emphysema, pneumothorax, intracranial hemorrhage and death. Especially babies with severe radiological findings profited from multiple-dose treatment with surfactant; mortality was reduced from 46% to 19% in these patients. In a subgroup additional radiograph of 35 patients were analysed. An asymmetric appearance of respiratory distress syndrome after surfactant therapy - as an expression of uneven distribution of surfactant in the lung - was observed on 20% of X-rays. This finding was not associated with relevant clinical problems. In addition a hazy, 'opaque' lung during weaning from respiratory support was temporarily seen in 84% of the infants; this phenomenon was not predictive for the development of bronchopulmonary dysplasia. In summary the therapeutic response to surfactant replacement therapy is reflected by radiological changes in respiratory distress syndrome. Radiological severity of respiratory distress syndrome before therapy showed a good correlation with neonatal morbidity and mortality. Asymmetric appearance of respiratory distress syndrome was not associated with relevant clinical problems.