Journal of the Korean Pediatric Society 1993;36(2):244-265.
Published online February 15, 1993.
Surfactant Replacement Therapy in Neonates with Respiratory Distress Syndrome: A Collective Evaluation of Trials from 16 Hospitals
CW Bae1, YD Kwon2, SJ Ko3, KS Kim4, HM Kim5, WS Park6, SH Byun7, CS Son8, HS Ahn9, SG Lee10, YP Chang11, YJ Chung12, KS Cho13, KH Cho14, KC Choeh15, MJ Chey16, JH Choi11, JK Yoon11, CI Ahn1, S Chida17, T Fujiwara17
1Kyunghee University, Hosp, Seoul
2Taegu Catholi hosp., Taegu
3Sowha Children`s Hosp., Seoul
4Seoul Chungang Hosp, Seoul
5Kyungpook National Univ. Hosp, Seoul
6Cha Women`s Hosp, Seoul
7Chungnam National Univ. Hosp, Daejeon
8Korea Univ. Hosp., Seoul
9Sungbundo Hosp., Pusan
10Taegu Fatima Hosp., Taegu
11Seoul National Univ. Hosp., Seoul
12Kosin Medical Center, Pusan
13Marynoll Hosp., Pusan
14Catholic Medical Univ., ST. Vincent Hosp., Suwon
15Eulji General, Hosp, Seoul
16Gil General, Hosp., Inchon
17Iwate Medical Univ., Morioka, Japan
신생아 RDS에서 인공 폐 Surfactant 보충요법:한국 다기관의 초기성적 및 사망관련인자의 분석
배종우1, 권영대2, 고세중3, 김기수4, 김행미5, 박원순6, 변상현7, 손창성8, 안호식9, 이상길10, 장영표11, 정윤주12, 조경숙13, 조규홍14, 최규철15, 최명재16, 최중환11, 윤종구11, 안창일1, 千田勝一17, 藤原哲郞17
1경희의대 소아과
2대구 가톨릭병원 소아과
3소화아동병원 소아과
4서울 중앙병원 소아과
5경북의대 소아과
6차병원 소아과
7충남의대 소아과
8고려의대 소아과
9부산 성분도병원 소아과
10대구 파티마병원 소아과
11서울의대 소아과
12고신의대 소아과
13부산 메리놀병원 소아과
14가톨릭의대 성빈센트 소아과
15대전 을지병원 소아과
16인천 중앙 길병원 소아과
17日本 岩手醫科大學 小兒科
Abstract
Surfactant replacement therapy in neonates with respiratory distress syndrome (RDS) has been introduced in our country since May 1990. The purpose of this study was to assess the effect and short-term outcome of surfactant replacement for neonatal RDS using collective data of uncontrolled trials from different hospitals in Korea. For the period May 1990 to Dec. 1991, a total of 68 RDS neonates were treated with a reconstituted bovine surfactant (Surfactant-TA) at 17 hospitals. Data on 60 neonates were collected from 16 hospitals and were analyzed in this study. In order to examine the factors that might influence the mortality, we performed a stepwise discriminant analysis. RDS was diagnosed according to accepted clinical and radiographic criteria at each hospital. The mean gestational age of 60 neonates was 31¡¾3 weeks (1 SD, range, 24~40 wk) and the mean birth improvement in ventilatory requirement during the subsequent clinical course. However, there were respirator settings after surfactant treatment. The neonatal mortality was 40% in this group. When improvement was significantly less in death group than that in survival group. Factors affecting the neonatal mortality include a poor response to surfactant, sepsis and/or DIC, decreasing gestational age and birth weight, acidosis before treatment and air-leaks. We conclude that treatment with Surfactant-TA has an impact on the clinical course of RDS. To optimize the effects of surfactant therapy, the following refinement will be needed: better initial stabilization with respect to blood pressure, blood gases and pH, instillation techniques including pre-and post-surfactant ventilation, weaning guidelines, dose, dose schedule, as well as timing of treatment, management of infection, and prevention of severe birth asphyxia.
Key Words: Neonatal respiratory distress syndrome, Surfactant replacement, Mortality


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