Expanding the Use of Surfactant Past Equivalent of Term
Presented by William Truog, MD
Surfactant replacement therapy for preterm infants with respiratory distress is nothing new at Children’s Mercy — or many other medical centers. Giving at-risk babies one to three doses of surfactant during their first 24 to 48 hours of life has been routine for 20 years.
But what about giving surfactant to preterm babies who are two to three weeks old? That’s what Children’s Mercy physicians and scientists are helping determine as part of a multi-center trial funded by the National Heart, Lung, and Blood Institute (NHLBI).
“While surfactant replacement therapy is a good treatment for their early days, many babies born at 30 weeks or less gestation go on to develop bronchopulmonary dysplasia (BPD) in later weeks,” says William Truog, MD, Sosland Chair in Neonatal Research.
Dr. Truog serves on the national steering committee for the NHLBI study, which builds on a previous trial done at Children’s Mercy and other medical centers. The earlier trial showed the positive effect of inhaled nitric oxide in preterm infants. The current trial adds surfactant replacement therapy to nitric oxide and other routine treatments.
Babies in the study get up to five additional doses of surfactant through their breathing tube, beginning in their second week of life.
“It’s the same FDA-approved surfactant product, same dose and same procedure as for day-old infants,” says Dr. Truog. “But it’s delivered to a 2- to 3-week-old lung, which may be vastly different than a day-old lung.”
The goal is to enroll 524 babies in the study nationwide. Currently, about one-third are enrolled.
“All babies in the study are watched very closely to prevent any potential adverse reaction to treatment,” says Dr. Truog. “The study’s data safety monitoring board also reviews each patient to ensure their protection. If the board sees significant disparities between patients in the test and placebo groups, it stops the study to ensure both groups can receive the best available treatment.”
The success of using surfactant replacement therapy in older preterm babies will depend on their condition at 36 weeks, 1 year and beyond. It’s still too early to get a sneak peek at the results.
There haven’t been many breakthroughs in preventing lung injuries like BPD in premature infants, notes Dr. Truog. But expanding the use of surfactant may change that.
“It’s another way we at Children’s Mercy are trying to produce long-term pulmonary outcomes that are comparable to or better than anywhere else in the world,” he says.