Combination of early endotracheal Surfactant and nasal continous positive airwaypressure (CPAP): 15–32-month outcome of extremly low birth weight preterm infants (ELBW)

Aims: Use of early nCPAP as well as intubation and ventilation with early Surfactant are both efficient therapies of IRDS. We combined both principles of therapy by applying Surfactant with an endotracheal catheter during nCPAP. Those ELBW-children treated in a trial of feasibility (n=42) were compared with an historical controllgroup (KG). Mortality and shortterm morbidity were lower in the interventional group (IG), so that a prospective, randomized controlled trial seamed to be justified.

Question: Do we find safety relevant differences in children of both groups in the age of 15–32 months?

Patients and methods: After discharge all children were invited to follow up regularly. Analyzed were results from the children which were examinated in the age of 15–32 months. Outcome criteria were bodyweight, length, head circumference, mental and motoric developmentscore (evaluation of a neuropediatrician and munich functional development assessment) and presence of central tonus- and coordination-disturbance, cerebral palsy, retardation of speech, impaired vision and hearing loss.

Results: Followed up were 21 patients from the KG and 28 patients from the IG. Children followed up of IG had significant lower birthweight and significant smaller head circumference than those from KG. All other neonatal output parameter did not differ. 4 (19%) patients of KG and 4 (14.3%) of IG were without pathological findings at date of follow up. We did not find any statisticly significant differences in functional and somatic Outcome in the age of 15–32 months.

Conclusion: Despite lower weight and headcircumference at birth children fro IG did not show worst outcome at age of 15–32 months than children from KG, so that even concerning this safety relevant aspect the required prospective randomised controlled tial is justified.