Early continuous positive airway pressure versus surfactant therapy in preterm neonates with respiratory distress

TL;DR

This study compares early CPAP and surfactant therapy in preterm neonates with respiratory distress, finding that each treatment is most effective in specific gestational age groups.

Contribution

The study identifies optimal treatment strategies for preterm neonates based on gestational age, offering guidance for resource-limited settings.

Findings

Early CPAP alone achieves high survival rates in 31-36-week preterm neonates.

Extremely preterm neonates (27-30 weeks) benefit more from combined CPAP-surfactant therapy.

Mortality in extremely preterm infants remains elevated due to pulmonary hemorrhage and sepsis.

Abstract

Respiratory Distress Syndrome (RDS) remains a major cause of morbidity and mortality in preterm neonates, particularly in resource-
limited Level 2 Special Newborn Care Units. Therefore, it is of interest to analyse outcomes of 308 preterm neonates treated with early
Continuous Positive Airway Pressure (CPAP) or combined CPAP-surfactant therapy across three gestational age groups. Survival was highest
with CPAP alone in moderate and late preterm neonates (31-36 weeks), reaching 84.4%-87.3%. Extremely preterm neonates (27-30 weeks) showed
improved outcomes with early selective surfactant plus CPAP, though mortality remained higher due to pulmonary hemorrhage and sepsis. Early
CPAP is highly effective for 31-36-week neonates, while extremely preterm infants benefit most from combined CPAP-surfactant therapy.