Publication:

Evaluation of varying thresholds of fraction of inspired oxygen on the need for surfactant administration and comorbidities among preterm neonates with respiratory distress syndrome: a prospective cohort study

Background Respiratory distress syndrome (RDS) in preterm neonates results from surfactant deficiency, causing alveolar collapse. Continuous positive airway pressure (CPAP) is the preferred initial support, with surfactant administration based on fraction of inspired oxygen (FiO2) thresholds. However, the optimal FiO2 threshold remains uncertain. To assess surfactant need in preterm neonates on CPAP requiring FiO2 30-40% based on Silverman-Anderson scores and FiO2 trends.

Methods This prospective cohort study was conducted at SMS Medical College, Jaipur, including preterm neonates (26-34 weeks' gestation) requiring CPAP. Neonates were categorized into three groups: Group A ( 40%). In Group B, surfactant was administered based on FiO2 trends and Silverman–Anderson scores.

Results Among 96 neonates, 70 (72.9%) received surfactant, while 26 (27.1%) did not. Higher FiO2 and Silverman-Anderson scores at 6 hours were significantly associated with surfactant need (p<0.0001). However, maternal factors (antenatal steroids, mode of delivery, Gravida) showed no significant association with surfactant use.

Conclusions Neonates requiring FiO2 30-40% on CPAP can often be managed without immediate surfactant administration if their Silverman-Anderson score and FiO2 improve within 6 hours. A FiO2 threshold of 35%, combined with clinical monitoring, may be a more effective criterion for surfactant therapy, reducing unnecessary administration.