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Mortality and Morbidity After Availability of Surfactant Therapy

Mari Palta, PhD; Marie R. Weinstein, MD; Gail McGuinness, MD; Debra Gabbert; William Brady, MS; Mary Ellen Peters, MD

Arch Pediatr Adolesc Med. 1994;148(12):1295-1301.

Abstract
Objective
To assess the impact of recent changes in neonatal intensive care on the mortality and morbidity of very-low-birth-weight neonates (<1501 g).

Design
Prospective cohort study.

Setting
Six neonatal intensive care units in Wisconsin and Iowa.

Participants
All very-low-birth-weight neonates who were admitted to the neonatal intensive care units the year before the availability of exogenous surfactant (n=333), during the investigational new drug protocol for synthetic surfactant (Exosurf) (n=347), and after the release of synthetic surfactant (n=356) (designated as periods 1,2, and 3, respectively).

Interventions
None.

Main Results
The percentage of neonates receiving exogenous surfactant in the three periods was 3%, 37%, and 56%, and the percentage receiving antenatal steroids was 12%, 17%, and 27% (P=.0001 for increase in both modalities). The percentage of neonates dying in the three periods was 23%, 14%, and 19% (P=.05 for downward trend). The percentage of neonates with intraventricular hemorrhage decreased in the subgroup weighing between 700 and 1350 g (35%, 28%, and 24%) (P=.04) and increased in the subgroup weighing below 700 g (8%, 41%, and 45%) (P=.03). The percentage of neonates with bronchopulmonary dysplasia increased from 21% to 36% between periods 1 and 2 (P=.003) and decreased to 27% (P=.04) in period 3. Antenatal steroid use was strongly associated with the decrease in intraventricular hemorrhage (odds ratio, 0.35) and mortality risk (odds ratio, 0.20).

Conclusions
Several developments in care have contributed to changes in mortality risk, incidence of intraventricular hemorrhage, and the severity of respiratory disease in very-low-birth-weight infants.

(Arch Pediatr Adolesc Med. 1994;148:1295-1301)

Author Affiliations
From the Departments of Preventive Medicine (Dr Palta, Ms Gabbert, and Mr Brady), Pediatrics (Dr Weinstein), and Radiology (Dr Peters), University of Wisconsin–Madison; the Department of Neonatology, St Mary's Hospital, Madison (Dr Weinstein); and the Department of Pediatrics, University of Iowa, Iowa City (Dr McGuinness). A complete list of the participants in the Newborn Lung Project appears at the end of this article.

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