When to treat with surfactant?

Synthesis of available data by different expert groups has resulted in differing fraction of inspired oxygen (FiO2) thresholds for surfactant therapy in babies with respiratory distress syndrome (RDS). Canadian Guidelines in 2021 suggested treatment when FiO2>0.5. Recent European Guidelines suggest treatment when FiO2>0.3. Branagan et al attempt through network meta-analysis to determine if there is an optimal FiO2 cut-off for surfactant therapy to reduce any of the important negative outcomes of prematurity including mortality and bronchopulmonary dysplasia (BPD). They show that there are no strong data from randomised trials supporting any particular cut-off, ranging between FiO2 0.3 and 0.5 and argue that randomised trials of different thresholds for surfactant are urgently needed. What should neonatologists do now, while acknowledging that we do not know everything, and further research may refine what we do? Does this new meta-analysis mean we should wait longer before we expose infants to unpleasant laryngoscopy...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - Category: Perinatology & Neonatology Authors: Tags: Editorials Source Type: research