Outcome of surfactant therapy in a tertiary referral centre in Sri Lanka

Objective To assess the outcome of surfactant therapy at a tertiary referral centre in Sri Lanka

Design, setting and method All babies treated with surfactant at Sri Jayewardenepura General Hospital during 2007 were included in the study. Data on weight, maturity, age of ventilation, age of surfactant therapy, ventilator settings before and after surfactant, arterial blood gas results before and after surfactant, details regarding pneumothorax and pulmonary haemorrhage, duration of ventilation and chronic lung disease at 28 days, 3 months, and 6 months were collected. Data analysis was done according to maturity groups.

Results Forty eight babies had surfactant therapy during the study period. The commonest indication was hyaline membrane disease (HMD) in prematures (45), followed by meconium aspiration syndrome (03). According to maturity, 22 (46%) were in 28- 33+ weeks, followed by 12 (25%) in < 28 weeks, 11 (23%) in 34-36+ weeks and 3 (6%) were >37 weeks (mature). Only 6 (12%) babies in 34-36+ weeks had transient hypoxia. None of them developed pneumothorax. Four (8%) had features suggestive of pulmonary haemorrhage 12-48 hours after surfactant replacement therapy. Four (8%) babies had chronic lung disease at 28 days of age and two of them were in babies < 28 weeks. The reduction in oxygen requirements was seen within 6 hours of therapy in 7/12, 18/22, 6/11 in < 28, 28-33+ and 34-36+ weeks babies respectively and in 12-24 hours in babies >37 weeks. There were 14 deaths comprising 5/12 of babies < 28 weeks, 5 /22 of 28-33+ weeks, 4/11 of 34- 36+ weeks. Duration of ventilation varied among the survivors; 5/7 babies of < 28 weeks needed >10 days of ventilation whereas 10/17 of 28-33+ weeks needed < 10 days of ventilation.

Conclusions Reduction in oxygen requirement was seen within 6 hours of surfactant therapy in 65% of babies. Only 16% of babies who had surfactant therapy developed complications such as pulmonary haemorrhage and chronic lung disease. Duration of ventilation varied according to the maturity of the baby.

Key words: surfactant therapy outcome, Sri Lanka

DOI: 10.4038/sljch.v38i1.571

Sri Lanka Journal of Child Health, 2009; 38: 25-27