Nasal continuous positive airway pressure following surfactant replacement for the treatment of neonatal respiratory distress syndrome.

To evaluate whether nasal continuous positive airway pressure (N-CPAP) could be an alternative to ventilator treatment in infants with severe respiratory distress syndrome (RDS) after surfactant treatment, we performed the trial on 15 newborn babies with birth weight > or = 1500 g. All babies were put on N-CPAP as soon as the diagnosis of RDS was established. The N-CPAP system that we used in this study consisted of no ventilator. When FiO2 > or = 0.7 was required for maintaining PaO2 > 50 mmHg, surfactant treatment was decided. After the tracheal instillation of surfactant (120 mg/kg body weight), the babies were randomly assigned into 2 groups. In the ventilator group (n = 7), the babies were connected to mechanical ventilation following surfactant instillation. In the N-CPAP group (n = 8), the babies were extubated immediately after instillation of surfactant and were connected to N-CPAP. There was a marked improvement in the ratio of arterial PO2 to alveolar PO2 (a/A PO2) immediately following surfactant treatment and the effect was sustained during the study period of 72 hours in both groups. No significant differences in a/A PO2 were noted in 2 groups. There was a significantly higher PaCO2 in the N-CPAP group than in the ventilator group. PaCO2 declined significantly in the ventilator group 8 hours after surfactant treatment. A delayed decline in PaCO2 until 48 hours after surfactant instillation in the N-CPAP group was noted.(ABSTRACT TRUNCATED AT 250 WORDS)