[Surfactant therapy in severe neonatal respiratory failure--multicenter study--I. Surfactant therapy in 264 premature infants of < 34 weeks with IRDS with special reference to "non-responders"].

As a part of a west german multicenter study (16 hospitals) 264 preterm neonates < 34 gestational weeks were treated with bovine surfactant (Alveofact, 50-200 mg/kgBW). Entry criterion was need of mechanical ventilation and FiO2 of > 0.5. Compared with a previous prophylactic study with the same surfactant product these patients were slightly more mature (median: 29 gestational weeks, 1260 g) but had a higher oxygen demand at the time of treatment (median FiO2: 0.82). Survival rate (28. d) was 82%. At this time 38% showed spontaneous respiration without, 16% with additional oxygen. The incidence of pulmonary interstitial emphysema was 22%, of pneumothorax 13%, and of PDA 33%. Severe intracranial hemorrhage (grade III or IV according to Papile) had 25%, ROP (any grade) 27%. Nonresponder showed a higher initial FiO2 of 0.94. With regard to umbilical artery pH, mode of delivery, birth weight, and maturity) they were similar to the responders. We did not find a parameter, by which we could predict the response to surfactant.