New Technique Helps Save Lives of Premature Babies
A new technique for treating premature babies with a substance extracted from amniotic fluid can dramatically improve the survival rate of infants suffering from respiratory distress syndrome, researchers reported today.
The researchers, working at UC San Diego and the University of Helsinki, found that treatment with surfactant improved the survival rate for infants by two-thirds over that of babies receiving the standard treatment.
They also found that the treatment cut the rate of chronic lung disease among the surviving babies by two-thirds. Babies receiving standard treatment spent nearly twice as long in intensive care as those treated with surfactant.
“The conclusion was: It does improve their overall outcome,” said Dr. T. Allen Merritt, an associate professor of pediatrics at UC San Diego and one of the two principal investigators. “We’ve reduced mortality and we’ve reduced morbidity substantially.”
About 40,000 infants are born in the United States each year with respiratory distress syndrome, also known as hyaline lung disease. Their lungs are poorly developed and lack surfactant, which should line the lungs and prevent collapse during exhalation.
Five thousand of those babies die each year. Survivors suffer complications, including emphysema.
The new study, reported today in the New England Journal of Medicine, involved 60 randomly chosen premature babies. Neither parents, obstetric nurses nor neonatal resuscitation teams were informed whether the child had received surfactant or standard treatment.
The surfactant used came from amniotic fluid collected during Caesarean section deliveries through a collection program at hospitals in San Diego County and Finland. The purified fluid was dripped through tubes inserted in the tracheas of 31 babies.
The other 29 babies received only air, using the traditional treatment called ventilation. All the babies were very premature and weighed about two pounds, having had only 24 to 29 weeks of gestation.
According to the report, 16% of the infants treated with surfactant had died by one month after birth, compared to 52% of those treated by ventilation. Sixteen percent of the babies treated with surfactant suffered lung damage, compared to 31% of the other group.
Finally, infants in the group treated with surfactant averaged 70 days in neonatal intensive care. Babies in the other group averaged 122 days.
In an interview last week before leaving the country, Merritt said he and Dr. Mikko Hallman of the University of Helsinki have embarked on a second trial. Its purpose is to study the optimal doses and best times to administer surfactant.
“Does it make other things worse or better in the newborn period? Does it have a good effect on the vessel that connects the lungs and aorta? Does it enhance the methods of ventilation we use?” Merritt said, listing the issues he hopes to address.
“There are a lot of still-unanswered questions,” he said. “But I think that these results are at least encouraging.”
Merritt added that one baby at each center failed to show any response to surfactant. “So, like everything else, this is not a cure-all,” he said. “Like so many other therapies, it is a help. We have a lot yet to learn about it.”
In San Diego County, pregnant women planning Caesarean deliveries are being encouraged to contact their obstetricians about participation in the surfactant donation program, which is sponsored by March of Dimes.
