Prophylactic oropharyngeal surfactant does little to reduce intubation risk in preemies

Administration of surfactant into the oropharynx of neonates delivered before 29 weeks of gestation falls short of reducing the rate of intubation in the first 120 hours of life, according to the results of POPART*.

Conducted at nine tertiary neonatal intensive care units across six European countries, POPART included 251 newborns born before 29 weeks of gestation (mean gestational age 26 weeks), none of whom had severe congenital anomalies.

The newborns were randomly assigned to receive oropharyngeal surfactant at birth in addition to continuous positive airway pressure (CPAP; n=126, 54.8 percent boys, mean birth weight 858 g) or CPAP alone (n=125, 50.4 percent boys, mean birth weight 829 g). Caregivers were aware of the group assignment.

Researchers recorded the incidence of intubation in the delivery room for bradycardia and/or apnoea or intubation in the neonatal intensive care unit for prespecified respiratory failure criteria within 120 hours of birth.

The proportion of newborns intubated within 120 hours did not significantly differ between the oropharyngeal surfactant group and the control group (63.5 percent vs 64.8 percent; relative risk, 0.98, 95 percent confidence interval, 0.81–1.18).

Of note, significantly more newborns in the oropharyngeal surfactant group received a diagnosis of pneumothorax and were treated for it (16.6 percent vs 6.4 percent; p=0.04).

The findings suggest that prophylactic oropharyngeal surfactant should not be routinely used.

*Prophylactic Oropharyngeal Surfactant for Preterm Infants