A review of surfactant use in neonates at Charlotte Maxeke Johannesburg academic hospital from January 2013 - June 2016

Ayodele, Oluwakemi Zainab
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Background: Surfactant replacement therapy (SRT) is an established treatment of respiratory distress syndrome globally. However, in sub-Saharan Africa there is limited recent information on the use of SRT. Objectives: To review the use of surfactant replacement therapy in neonates at Charlotte Maxeke Johannesburg Academic Hospital. Methods: This was a cross-sectional descriptive study. The population included all neonates, term and preterm, admitted within 72hours after birth at Charlotte Maxeke Johannesburg Academic Hospital between 1 January and 30 June 2016. Maternal and neonatal characteristics of neonates who received surfactant were compared to those who did not receive surfactant therapy. Results: A total of 5517 neonates were included in the study. Surfactant replacement therapy was strongly associated with birth weight – 69.7% (1179/1609) very low birth weight (<1500 g) neonates received surfactant compared to 16.3% (624/3828) LBW (p<0.001). In very low birth weight neonates, surfactant replacement therapy was associated with the presence of a patent ductus arteriosus (p=0.03), respiratory distress syndrome (p<0.001), the use of mechanical ventilation (p<0.001), the use of nasal CPAP (p<0.001) and supplemental oxygen at 28 days (p=0.012). In LBW, surfactant replacement was similarly associated with respiratory distress syndrome (p<0.001), the need for nasal CPAP (p<0.001) and resuscitation at birth (p=0.026). In all neonates, surfactant replacement was associated with increased duration of hospital stay. SRT was used in term and near-term neonates for the treatment of meconium aspiration syndrome (8.6%), persistent pulmonary hypertension of the neonate (4.3%) and congenital pneumonia (5.1%). This study confirms that most preterm neonates with respiratory distress syndrome in the study hospital were treated with surfactant replacement therapy and nasal CPAP. This is in keeping with global neonatal practices. Protocols to decrease neonatal mortality in low and middlee-income countries must include the provision of surfactant replacement therapy and nasal CPAP for the treatment of preterm infants.
Master of Medicine (Paediatrics