Developments in Brief : Study Shows Less Is Better With Ill Babies
Premature or low-birth-weight infants with breathing problems do much better without the aggressive use of respirators, drugs and other invasive procedures, a Harvard study has found.
In a related finding, the researchers also said an experimental fluid called surfactant, derived from cows’ lungs, appears to greatly increase the survival of premature infants suffering from respiratory distress syndrome. Results of both studies were published in the journal Pediatrics.
About 36,000 babies born in the United States each year weigh less than 3 pounds, 3 ounces, and most of them are at risk of developing respiratory problems.
Dr. Mary Ellen Avery and her colleagues investigated the treatment of 1,625 such infants at eight hospital nurseries and found that one nursery had much better results than the others.
New York’s Columbia-Presbyterian Medical Center did 16.5% better than expected, Avery said. Other centers had results as much as 10% worse than expected. The researchers attributed Columbia’s results to the less aggressive treatments, which allowed infants to fight the disorder themselves.
“We thought we would find differences, but nobody anticipated this result,” Avery said. “It’s a terribly important observation. One can’t ignore the fact that whatever the reason, Columbia has a better outcome.”
Rather than putting premature babies immediately on mechanical respiration and inserting tubes into the lungs, doctors at Columbia first use soft plastic prongs to keep nasal passages open, coupled with low-pressure administration of oxygen.
If a baby does require breathing tubes, the pressure and level of oxygen is kept to a minimum, and every effort is made to get the infant off the respirator as early as possible, said Dr. L. Stanley James, Columbia’s director of perinatology.
“The overall philosophy we have developed over the years is to keep the trauma to an absolute minimum,” he said. “The babies do better that way.”
The second Harvard study, conducted by Dr. H. William Taeusch, found bovine surfactant to be an effective treatment for infants who developed severe respiratory distress.
Surfactant is an oily substance found in the lungs of normal babies and adults but lacking in premature or low-birth-weight infants. Scientists believe surfactant deficiency is the main cause of early breathing problems in these babies.
Previous studies have shown that surfactant can prevent respiratory difficulties, but Taeusch said his study shows that surfactant can also “perform a rescue function for infants who have already developed problems.”
In Taeusch’s study, 41 preemies were randomly treated either with a half-teaspoon of surfactant or with salt water within seven hours of birth. Two out of three of those receiving surfactant improved dramatically within hours and needed significantly less respiratory care.
