Decreasing mortality associated with the introduction of surfactant therapy

An observational study of neonates weighing 601 to 1300 grams at birth

J. D. Horbar, E. C. Wright, L. Onstad, J. B. Philips, G. Cassady, A. A. Fanaroff, M. Hack, W. Edwards, G. A. Little, K. A. Foley, C. R. Bauer, E. S. Bandstra, S. J. Yaffe, L. L. Wright, Michael Malloy, S. B. Korones, R. Cooke, J. E. Tyson, R. D. Uauy

Research output: Contribution to journalArticle

186 Citations (Scopus)

Abstract

Objective. To determine whether the introduction of surfactant therapy was associated with decreased mortality for high-risk preterm neonates weighing 601 to 1300 g at birth. Design. Before-after observational study. Setting. Eight tertiary care neonatal intensive care units participating in the National Institute of Child Health and Human Development Neonatal Research Network. Patients. The outcomes for neonates with birth weight 601 to 1300 g admitted in the 2 years before surfactants became available (n = 2780) were compared with those of neonates admitted in the year beginning 2 months after surfactants became available (n = 1413). Main outcome measures. The primary outcome measure was in-hospital mortality; secondary outcome measures included durations of assisted ventilation, length of hospitalization, and neonatal morbidity. Results. Forty percent of neonates in the postsurfactant group received surfactant (range 28% to 69% at the centers). Mortality decreased from 27.8% before to 19.9% after surfactant therapy was introduced (Mantel-Haenszel χ2 = 31.4, P = .001). The adjusted odds ratio for mortality after surfactants became available was 0.73 (95% confidence interval 0.55 to 0.95). The duration of assisted ventilation and length of hospitalization increased after surfactants were introduced (P = .0001 for both outcomes). Conclusion. Mortality for neonates weighing 601 to 1300 g decreased after surfactant therapy was introduced, suggesting that the efficacy of surfactants demonstrated in randomized controlled trials will translate into effectiveness in routine clinical care.

Original languageEnglish (US)
Pages (from-to)191-196
Number of pages6
JournalPediatrics
Volume92
Issue number2 I
StatePublished - 1993
Externally publishedYes

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Surface-Active Agents
Observational Studies
Parturition
Newborn Infant
Mortality
Therapeutics
Outcome Assessment (Health Care)
Ventilation
Hospitalization
National Institute of Child Health and Human Development (U.S.)
Neonatal Intensive Care Units
Tertiary Healthcare
Hospital Mortality
Birth Weight
Randomized Controlled Trials
Odds Ratio
Confidence Intervals
Morbidity
Research

Keywords

  • before-after trial
  • mortality
  • neonate
  • outcomes
  • surfactant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Horbar, J. D., Wright, E. C., Onstad, L., Philips, J. B., Cassady, G., Fanaroff, A. A., ... Uauy, R. D. (1993). Decreasing mortality associated with the introduction of surfactant therapy: An observational study of neonates weighing 601 to 1300 grams at birth. Pediatrics, 92(2 I), 191-196.

Decreasing mortality associated with the introduction of surfactant therapy : An observational study of neonates weighing 601 to 1300 grams at birth. / Horbar, J. D.; Wright, E. C.; Onstad, L.; Philips, J. B.; Cassady, G.; Fanaroff, A. A.; Hack, M.; Edwards, W.; Little, G. A.; Foley, K. A.; Bauer, C. R.; Bandstra, E. S.; Yaffe, S. J.; Wright, L. L.; Malloy, Michael; Korones, S. B.; Cooke, R.; Tyson, J. E.; Uauy, R. D.

In: Pediatrics, Vol. 92, No. 2 I, 1993, p. 191-196.

Research output: Contribution to journalArticle

Horbar, JD, Wright, EC, Onstad, L, Philips, JB, Cassady, G, Fanaroff, AA, Hack, M, Edwards, W, Little, GA, Foley, KA, Bauer, CR, Bandstra, ES, Yaffe, SJ, Wright, LL, Malloy, M, Korones, SB, Cooke, R, Tyson, JE & Uauy, RD 1993, 'Decreasing mortality associated with the introduction of surfactant therapy: An observational study of neonates weighing 601 to 1300 grams at birth', Pediatrics, vol. 92, no. 2 I, pp. 191-196.
Horbar, J. D. ; Wright, E. C. ; Onstad, L. ; Philips, J. B. ; Cassady, G. ; Fanaroff, A. A. ; Hack, M. ; Edwards, W. ; Little, G. A. ; Foley, K. A. ; Bauer, C. R. ; Bandstra, E. S. ; Yaffe, S. J. ; Wright, L. L. ; Malloy, Michael ; Korones, S. B. ; Cooke, R. ; Tyson, J. E. ; Uauy, R. D. / Decreasing mortality associated with the introduction of surfactant therapy : An observational study of neonates weighing 601 to 1300 grams at birth. In: Pediatrics. 1993 ; Vol. 92, No. 2 I. pp. 191-196.
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T2 - An observational study of neonates weighing 601 to 1300 grams at birth

AU - Horbar, J. D.

AU - Wright, E. C.

AU - Onstad, L.

AU - Philips, J. B.

AU - Cassady, G.

AU - Fanaroff, A. A.

AU - Hack, M.

AU - Edwards, W.

AU - Little, G. A.

AU - Foley, K. A.

AU - Bauer, C. R.

AU - Bandstra, E. S.

AU - Yaffe, S. J.

AU - Wright, L. L.

AU - Malloy, Michael

AU - Korones, S. B.

AU - Cooke, R.

AU - Tyson, J. E.

AU - Uauy, R. D.

PY - 1993

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N2 - Objective. To determine whether the introduction of surfactant therapy was associated with decreased mortality for high-risk preterm neonates weighing 601 to 1300 g at birth. Design. Before-after observational study. Setting. Eight tertiary care neonatal intensive care units participating in the National Institute of Child Health and Human Development Neonatal Research Network. Patients. The outcomes for neonates with birth weight 601 to 1300 g admitted in the 2 years before surfactants became available (n = 2780) were compared with those of neonates admitted in the year beginning 2 months after surfactants became available (n = 1413). Main outcome measures. The primary outcome measure was in-hospital mortality; secondary outcome measures included durations of assisted ventilation, length of hospitalization, and neonatal morbidity. Results. Forty percent of neonates in the postsurfactant group received surfactant (range 28% to 69% at the centers). Mortality decreased from 27.8% before to 19.9% after surfactant therapy was introduced (Mantel-Haenszel χ2 = 31.4, P = .001). The adjusted odds ratio for mortality after surfactants became available was 0.73 (95% confidence interval 0.55 to 0.95). The duration of assisted ventilation and length of hospitalization increased after surfactants were introduced (P = .0001 for both outcomes). Conclusion. Mortality for neonates weighing 601 to 1300 g decreased after surfactant therapy was introduced, suggesting that the efficacy of surfactants demonstrated in randomized controlled trials will translate into effectiveness in routine clinical care.

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