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Surfactant Prophylaxis and Retinopathy of Prematurity

Surfactant Prophylaxis and Retinopathy of Prematurity Abstract • Objective. —The use of exogenous surfactant has led to a decrease in mortality of low-birth-weight infants. In some instances, use of this drug has also led to a reduction in neonatal morbidity, such as respiratory distress syndrome. This study was undertaken to determine whether prophylactic surfactant therapy has an effect on the incidence and severity of retinopathy of prematurity. Design. —The authors reviewed the findings of sequential prospective ophthalmologic examinations performed in two neonatal intensive care units that participated in randomized trials of prophylactic exogenous mammalian surfactant. Patients. —There were 43 patients in the control group (no prophylactic surfactant) and 43 patients in the prophylactic surfactant group. These groups did not differ on the basis of birth weight, gestational age, race, or gender. Results. —The incidence and severity of retinopathy of prematurity did not vary between the control and surfactant-treated infants. Only birth weight appeared to be significantly related to the incidence and severity of retinopathy of prematurity. Conclusions. —These results suggest that the widespread use of prophylactic surfactant therapy will not change the incidence of retinopathy of prematurity in extremely low-birth-weight infants. However, the absolute number of affected patients will likely increase because of the decrease in mortality of extremely low-birth-weight patients, the patients most at risk for retinopathy of prematurity. References 1. Biglan AW, Brown DR, Macpherson TA. Update on retinopathy of prematurity . Semin Perinatol . 1986;10:187-195. 2. Gibson DL, Sheps SB, Uh SH, Schechter MT, McCormick AQ. Retinopathy of prematurity-induced blindness: birth weight-specific survival and the new epidemic . Pediatrics . 1990;86:405-412. 3. Shapiro DL, Notter RH, Morin FC III, et al. Double-blind, randomized trial of a calf lung surfactant extract administered at birth to very premature infants for prevention of respiratory distress syndrome . Pediatrics . 1985;76:593-599. 4. Enhorning G, Shennan A, Possmayer F, et al. Prevention of neonatal respiratory distress syndrome by tracheal instillation of surfactant: a randomized clinical trial . Pediatrics . 1985;76:145-153. 5. Kwong MS, Egan EA, Notter RH, et al. Double-blind clinical trial of calf lung surfactant extract for the prevention of hyaline membrane disease in extremely premature infants . Pediatrics . 1985;76:585-592. 6. Kendig JW, Notter RH, Cox C, et al. Surfactant replacement therapy at birth: final analysis of a clinical trial and comparisons with similar trials . Pediatrics . 1988;82:756-762. 7. Merritt TA, Hallman M, Bloom BT, et al. Prophylactic treatment of very premature infants with human surfactant . N Engl J Med . 1986;315:785-790.Crossref 8. Dunn MS, Shennan AT, Hoskins EM, Lennox K, Enhorning G. Two-year follow-up of infants enrolled in a randomized trial of surfactant replacement therapy for prevention of neonatal respiratory distress syndrome . Pediatrics . 1988;82:543-547. 9. Ware J, Taeusch HW, Soll RF, McCormick MC. Health and development outcomes of a surfactant controlled trial: follow-up at 2 years . Pediatrics . 1990;85:1103-1107. 10. Soll RF, Hoekstra RE, Fangman JJ, Ross Collaborative Surfactant Prevention Study Group. Multicenter trial of single-dose modified bovine surfactant extract (Survanta) for prevention of respiratory distress syndrome . Pediatrics . 1990;85:1092-1102. 11. Kendig JW, Noter RH, Cox C, et al. A comparison of surfactant as immediate prophylaxis and as rescue therapy in newborns of less than 30 weeks' gestation . N Engl J Med . 1991;324:865-871.Crossref 12. Dunn MS, Shennan AT, Zayack D, Possmayer F. Bovine surfactant replacement therapy in neonates of less than 30 weeks' gestation: a randomized controlled trial of prophylaxis versus treatment . Pediatrics . 1991;87:377-386. 13. Corbet A, Bucciarelli R, Goldman S, Mammel M, Wold D, Long W, American Exosurf Pediatric Study Group 1. Decreased mortality rate among small premature infants treated at birth with a single dose of synthetic surfactant: a multicenter controlled trial . J Pediatr . 1991;118:277-284.Crossref 14. Bose C, Corbet A, Bose G. et al. Improved outcome at 28 days of age for very low birth weight infants treated with a single dose of a synthetic surfactant . J Pediatr . 1990;117:947-953.Crossref 15. Possmayer F. Bovine surfactant replacement therapy in neonates of less than 30 weeks' gestation: a randomized controlled trial of prophylaxis versus treatment . Pediatrics . 1991;87:377-386. 16. Hoekstra RE, Jackson JC, Myers TF, et al. Improved neonatal survival following multiple doses of bovine surfactant in very premature neonates at risk for respiratory distress syndrome . Pediatrics . 1991;88:10-18. 17. Merritt TA, Halman M, Berry C, et al. Randomized, placebo-controlled trial of human surfactant given at birth versus rescue administration in very low birth weight infants with lung immaturity . J Pediatr . 1991;118:581-594.Crossref 18. Repka MX, Hudak ML, Parsa CF, Tielsch, JM. Calf lung surfactant extract prophylaxis and retinopathy of prematurity . Ophthalmology . 1992;99:531-536.Crossref 19. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: preliminary results . Arch Ophthalmol . 1988;106:471-479.Crossref 20. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: one-year outcome-structure and outcome . Arch Ophthalmol . 1990;108:1408-1416.Crossref 21. Palmer EA, Flynn JT, Hardy RJ, et al. Incidence and early course of retinopathy of prematurity . Ophthalmology . 1991;98:1628-1640.Crossref 22. The Committee for the Classification of Retinopathy of Prematurity. An international classification for retinopathy of prematurity . Arch Ophthalmol . 1984;102:1130-1134.Crossref 23. Rankin STA, Tubman TRJ, Halliday HL, Johnston SS. Surfactant and ROP incidence . Ophthalmology . 1991;98:1148-1149.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Surfactant Prophylaxis and Retinopathy of Prematurity

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References (25)

Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1993.01090050052027
Publisher site
See Article on Publisher Site

Abstract

Abstract • Objective. —The use of exogenous surfactant has led to a decrease in mortality of low-birth-weight infants. In some instances, use of this drug has also led to a reduction in neonatal morbidity, such as respiratory distress syndrome. This study was undertaken to determine whether prophylactic surfactant therapy has an effect on the incidence and severity of retinopathy of prematurity. Design. —The authors reviewed the findings of sequential prospective ophthalmologic examinations performed in two neonatal intensive care units that participated in randomized trials of prophylactic exogenous mammalian surfactant. Patients. —There were 43 patients in the control group (no prophylactic surfactant) and 43 patients in the prophylactic surfactant group. These groups did not differ on the basis of birth weight, gestational age, race, or gender. Results. —The incidence and severity of retinopathy of prematurity did not vary between the control and surfactant-treated infants. Only birth weight appeared to be significantly related to the incidence and severity of retinopathy of prematurity. Conclusions. —These results suggest that the widespread use of prophylactic surfactant therapy will not change the incidence of retinopathy of prematurity in extremely low-birth-weight infants. However, the absolute number of affected patients will likely increase because of the decrease in mortality of extremely low-birth-weight patients, the patients most at risk for retinopathy of prematurity. References 1. Biglan AW, Brown DR, Macpherson TA. Update on retinopathy of prematurity . Semin Perinatol . 1986;10:187-195. 2. Gibson DL, Sheps SB, Uh SH, Schechter MT, McCormick AQ. Retinopathy of prematurity-induced blindness: birth weight-specific survival and the new epidemic . Pediatrics . 1990;86:405-412. 3. Shapiro DL, Notter RH, Morin FC III, et al. Double-blind, randomized trial of a calf lung surfactant extract administered at birth to very premature infants for prevention of respiratory distress syndrome . Pediatrics . 1985;76:593-599. 4. Enhorning G, Shennan A, Possmayer F, et al. Prevention of neonatal respiratory distress syndrome by tracheal instillation of surfactant: a randomized clinical trial . Pediatrics . 1985;76:145-153. 5. Kwong MS, Egan EA, Notter RH, et al. Double-blind clinical trial of calf lung surfactant extract for the prevention of hyaline membrane disease in extremely premature infants . Pediatrics . 1985;76:585-592. 6. Kendig JW, Notter RH, Cox C, et al. Surfactant replacement therapy at birth: final analysis of a clinical trial and comparisons with similar trials . Pediatrics . 1988;82:756-762. 7. Merritt TA, Hallman M, Bloom BT, et al. Prophylactic treatment of very premature infants with human surfactant . N Engl J Med . 1986;315:785-790.Crossref 8. Dunn MS, Shennan AT, Hoskins EM, Lennox K, Enhorning G. Two-year follow-up of infants enrolled in a randomized trial of surfactant replacement therapy for prevention of neonatal respiratory distress syndrome . Pediatrics . 1988;82:543-547. 9. Ware J, Taeusch HW, Soll RF, McCormick MC. Health and development outcomes of a surfactant controlled trial: follow-up at 2 years . Pediatrics . 1990;85:1103-1107. 10. Soll RF, Hoekstra RE, Fangman JJ, Ross Collaborative Surfactant Prevention Study Group. Multicenter trial of single-dose modified bovine surfactant extract (Survanta) for prevention of respiratory distress syndrome . Pediatrics . 1990;85:1092-1102. 11. Kendig JW, Noter RH, Cox C, et al. A comparison of surfactant as immediate prophylaxis and as rescue therapy in newborns of less than 30 weeks' gestation . N Engl J Med . 1991;324:865-871.Crossref 12. Dunn MS, Shennan AT, Zayack D, Possmayer F. Bovine surfactant replacement therapy in neonates of less than 30 weeks' gestation: a randomized controlled trial of prophylaxis versus treatment . Pediatrics . 1991;87:377-386. 13. Corbet A, Bucciarelli R, Goldman S, Mammel M, Wold D, Long W, American Exosurf Pediatric Study Group 1. Decreased mortality rate among small premature infants treated at birth with a single dose of synthetic surfactant: a multicenter controlled trial . J Pediatr . 1991;118:277-284.Crossref 14. Bose C, Corbet A, Bose G. et al. Improved outcome at 28 days of age for very low birth weight infants treated with a single dose of a synthetic surfactant . J Pediatr . 1990;117:947-953.Crossref 15. Possmayer F. Bovine surfactant replacement therapy in neonates of less than 30 weeks' gestation: a randomized controlled trial of prophylaxis versus treatment . Pediatrics . 1991;87:377-386. 16. Hoekstra RE, Jackson JC, Myers TF, et al. Improved neonatal survival following multiple doses of bovine surfactant in very premature neonates at risk for respiratory distress syndrome . Pediatrics . 1991;88:10-18. 17. Merritt TA, Halman M, Berry C, et al. Randomized, placebo-controlled trial of human surfactant given at birth versus rescue administration in very low birth weight infants with lung immaturity . J Pediatr . 1991;118:581-594.Crossref 18. Repka MX, Hudak ML, Parsa CF, Tielsch, JM. Calf lung surfactant extract prophylaxis and retinopathy of prematurity . Ophthalmology . 1992;99:531-536.Crossref 19. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: preliminary results . Arch Ophthalmol . 1988;106:471-479.Crossref 20. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: one-year outcome-structure and outcome . Arch Ophthalmol . 1990;108:1408-1416.Crossref 21. Palmer EA, Flynn JT, Hardy RJ, et al. Incidence and early course of retinopathy of prematurity . Ophthalmology . 1991;98:1628-1640.Crossref 22. The Committee for the Classification of Retinopathy of Prematurity. An international classification for retinopathy of prematurity . Arch Ophthalmol . 1984;102:1130-1134.Crossref 23. Rankin STA, Tubman TRJ, Halliday HL, Johnston SS. Surfactant and ROP incidence . Ophthalmology . 1991;98:1148-1149.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: May 1, 1993

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