NEW YORK (Reuters Health) – Among spontaneously breathing, very premature infants, surfactant therapy administered within the first hour of life along with nasal continuous positive airway pressure (CPAP) decreases the need for mechanical ventilation and may prevent chronic lung disease, according to a multicenter trial conducted in Columbia.

The study, published in the January issue of Pediatrics, included 279 infants born between 27 weeks and less than 32 weeks of gestation with mild-to-moderate respiratory distress. Within the first hour, the infants were randomly assigned to the treatment group (intubation, very early surfactant, extubation, and nasal CPAP, n = 141) or the control group (nasal CPAP alone, n = 138).

A modified natural bovine lung surfactant (Survanta, Abbott Labs) was administered at a dose of 100 mg/kg in two aliquots, 2 minutes apart. All patients received aminophylline as long as they remained on nasal CPAP (average 4-5 days).

Early surfactant treatment was associated with significantly reduced need for mechanical ventilation (26% vs 39%), incidence of pneumothorax or pulmonary interstitial emphysema (2% vs 9%), and rescue treatment with surfactant (12% vs 26%).

There was also a nonsignificant trend toward reduced incidence of chronic lung disease, defined as oxygen treatment at 36 weeks