Surfactant reduced the mortality of neonates with birth weight ≥1500 g and hypoxemic respiratory failure: a survey from an emerging NICU network

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We evaluated the efficacy of surfactant therapy and assisted ventilation on morbidity and mortality of neonates with birth weight (BW) ≥1500 g and hypoxemic respiratory failure (HRF).


We retrospectively analyzed 5650 patients with BW ≥1500 g for incidence, management and outcome of HRF, defined as acute hypoxemia requiring mechanical ventilation and/or nasal continuous positive airway pressure ≥24 h. The patients were allocated into groups of moderate preterm (1735, 30.7%), late preterm (1431, 25.4%), early term (ETM, 986, 17.5%), full term (1390, 24.6%) and post term (79, 1.4%), with gestational age ≤ 33, 34 to 36, 37 to 38, 39 to 41 and ≥42 weeks, respectively.


In the five groups, 66.9, 42, 21.6, 12.8 and 5.1% had respiratory distress syndrome (RDS). For pneumonia/sepsis and meconium aspiration syndrome (MAS), the proportion was 13.8%, 25.4%, 38.0%, 52.5% and 76.0%, respectively. Surfactant was given to 21.9% (n = 1238) of HRF and 51.2% (n = 1108) of RDS. Survival rates of RDS were 82.2%, 87.8%, 84.5%, 77.1% and 75.0%, respectively (numbers needed to treat was 8 to 11 for surfactant benefit). Overall mortality rate of HRF was 21%, or 17.9%, 14.7%, 25.6%, 28.9% and 39.2%, respectively. Mortalities of MAS and pneumonia/sepsis were 29.4 and 27.6%. Relative risk of death was associated with initial disease severity, female gender, mechanical ventilation and congenital anomalies by multivariate logistic regression analysis.


Surfactant was effective for infants with RDS and BW ≥ 1500 g, and different incidences and outcome of HRF among GA groups reflected standard of perinatal and respiratory care in emerging neonatal intensive care unit network.

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