OBJECTIVES

: This study aims to compare selective and prophylactic surfactant administration in terms of their clinical effects in preterm infants born at less than 30 weeks gestation or birth weight (BW) less than of equal 1,250 grams from the Korean Neonatal Network (KNN) registry data.

METHODS

: This was a retrospective study of 4,453 infants born from January 2013 to December 2015 registered in the Korea Neonatal Network database. Stratification-matching was performed to eliminate the bias of outcome variables resulting from any differences of baseline characteristics between the selective and prophylactic treatment groups. Prophylactic use (P) group (n=3,167) and selective use (S) group (n=1,286) was matched with similar propensity score (gestational age, BW and antenatal steroid use). Primary outcomes were mortality and bronchopulmonary dysplasia (BPD). Other morbidities before discharge were also analyzed. Subgroup analysis was performed according to gestational age, BW and antenatal steroid use.

RESULTS

: A total of 1,027 infants in each group were matched. In the multivariate conditional logistic regression after adjusting, the selective treatment group had a significantly higher odds ratio (1.52, 95% CI 1.11, 2.06).In the subgroup analysis, there were no significant differences between the two groups in all primary outcome variables, including death before discharge, neonatal death, and BPD among survivors, in infants born after 30 weeks gestational age. There were no significant differences in all outcome indices between the prophylactic and selective treatment groups among infants born after 30 weeks gestational age with a birth weight below 1,250 g.

CONCLUSIONS

: In preterm infants at risk of RDS, prophylactic use of surfactant prevents the mortality before discharge and BPD. However, selective use of surfactant may be applied clinically to avoid unnecessary use of surfactant without increasing mortality and BPD in infants with more than 30 weeks gestation and complete antenatal steroid use.