Gestational age can predict the need for prophylaxis with surfactant therapy.

Controversy exists as to whether prophylactic or rescue therapy with surfactant should be used in infants born at less than 30 weeks gestation. We developed the hypothesis that gestational age can be used to predict a need for prophylactic surfactant therapy. We designed this retrospective study to determine whether there was a gestational age below which one could accurately predict the need for prophylactic surfactant therapy in almost all infants and limit unnecessary treatment of infants. We conducted a retrospective study of infants born at 23-34 weeks' gestation to determine the frequency with which surfactant therapy was used in a rescue strategy at each gestational age, and to ascertain the sensitivity, specificity, and predictive values of gestational age as a predictor of the use of surfactant therapy. There was a significant inverse correlation between gestational age and the proportion of infants treated with surfactant (r = -0.923, p < 0.001). A gestational age cut-off of 26 completed weeks' had a positive predictive value of 85% and a specificity of 96% for the need for surfactant therapy. We conclude that gestational age can be used to predict a need for surfactant therapy in premature infants. At our institution, the failure to attain 26 completed weeks' gestation will accurately predict the need for surfactant therapy and will result in unnecessary treatment of very few infants. We suggest that each institution caring for very low birth weight infants should examine its population to determine the gestational age at which they can accurately predict the need for prophylaxis with surfactant therapy.