Surfactant replacement treatment via a thin catheter or an intubation tube in preterm infants with respiratory distress syndrome below 34 gestational weeks

Aim: To evaluate the applicability and potential effectiveness of a technique of surfactant replacement treatment via a thin catheter and compare it with the intubation tube method in preterm infants with respiratory distress syndrome. Materials and Methods: Between February 2011 and March 2012, the infants born in our hospital with gestational age >26 and <34 weeks were enrolled in the study. The infants with major congenital anomaly, hydrops fetalis, those intubated in the delivery room, those without any respiratory distress, or those who did not need surfactant were excluded. The infants were randomly assigned into two groups. While the infants in ?intubation tube group? recieved surfactant with an intubation tube, the the infants in the ?catheter group? recieved it with a thin catheter. All infants were on continuous positive airway pressure starting from the delivery room and after surfactant replacement. The surfactant was given as prophylaxis to infants <28 weeks, however infants older than 28 weeks recieved surfactant according to the following indications: clinically or radiologically diagnosed significant respiratory distress or FiO2 need > 35% while on continuous positive airway pressure. Surfactant was used at the dosage of 100 mg/kg per dose. The data of the infants were recorded until hospital discharge. Results: Of the183 infants enrolled in the study, 38 infants (20.7%) fulfilled the inclusion criteria and received surfactant treatment via a thin catheter or an intubation tube. Each group included 19 infants. The grups were similar regarding to demographic characteristics, severity of respiratory distress on chest radiogram, the type, number and the indications of surfactant and the success of surfactant replacement procedure but there was a statistically significant difference between complications during the procedures. The intubation tube method was performed without any complications in 95% of infants, however desaturation was observed 37% in the catheter group (p=0.042). Blood gas alterations in time were better in intubation tube group (p<0.05). Duration of total parenteral nutrition, lipid infusion and carbapenem treatment were longer in the catheter group (p<0.05). Conclusion: Although both procedures are applicable and effective in preterm infants with respiratory distress syndrome, surfactant replacement with a thin catheter has a relatively higher desaturation risk. Catheter method is not superior to intubation tube method regarding these clinical and laboratuary results.