Two controlled trials of dry artificial surfactant: early effects and later outcome in babies with surfactant deficiency.

Dry powdered surfactant was used in two randomised, controlled trials to study its immediate effects, influence on mortality, and safety in babies born after less than 32 weeks' gestation. The lecithin/sphingomyelin (L/S) ratio was measured in pharyngeal aspirate taken before surfactant therapy to establish surfactant deficiency. 32 babies intubated during resuscitation (trial I) and a group of 24 other babies, all with immature L/S ratios, in whom severe hyaline membrane disease developed (trial II), were stratified for sex. In half 25 mg surfactant was insufflated through the endotracheal tube; it could be detected in tracheal secretions for at least the next 24 h. There was no significant difference in ventilator pressures or oxygen therapy used nor in neonatal mortality and morbidity in the first 2 years of life between the surfactant-treated and control groups in either trial.