Surfactant-Substitution beim schweren Atemnotsyndrom Frühgeborener < 1000 g  

19 preterm infants with severe respiratory distress syndrome (RDS) were treated with a single dose of natural porcine surfactant (Curosurf, 200 mg/kg). 9 patients had a birth weight of <1000 g (845 ± 112 g, mean ± SD and the mean gestational age was 27.2 ± 2.1 weeks). The other 10 had a birth weight of >1000 g (1521 ± 218 g and a mean gestationl age 31 ± 2.8 weeks). Age at treatment was 3 h in infants <1000 g and 4 h in patients >1000 g. Both groups of infants showed a rapid improvement in oxygenation and gas exchange within minutes after surfactant replacement. Exposition to >60% and >40% oxygen was identical in both groups. However, time in >21 % oxygen was significantly longer in infants <1000 g (median 30 days, 8.5 days in patients >1000 g, p <0.01). The duration of mechanical ventilation was 33 days, in patients >1000 g and 5 days; p <0.01. None of the infants developed a pneumothorax, but 6 out of 9 patients <1000 g developed mild bronchopulmonary dysplasia. 2 infants <1000 g died at day 5 and day 11 from cardio-circulatory arrest following ligation of a patent ductus arteriosus, and nosocomial septicaemia, respectively. Prolonged mechanical ventilation and exposure to oxygen in patients <1000 g cannot be attributed to surfactant deficiency alone. Immaturity of the lung pulmonary edema in patients with persistent ductus arteriosus, and other pulmonary as well as extrapulmonary complications probably contribute to the prolonged ventilatory requirements in the group of premature births of <1000 g.