Administration of surfactant to premature neonates with RDS does not increase the significance of patent ductus arteriosus

Surfactant (S) administration to premature neonates with RDS improves oxygenation and, consequently, with decrease of pulmonary vascular resistance, it may enhance left to right ductal shunting. Although a higher incidence of persistent ductus arteriosus (PDA) was not confirmed, there is still concern about its earlier and more severe manifestation. We evaluated 109 premature neonates, gestational age 29.5 weeks (SD 2.6), birth weight 1353 g (SD 516) with RDS (40 severe, 69 moderate) who received rescue treatment with bovine S and compared them with 20 control patients. The need for therapeutic PDA intervention (indomethacin and/or surgical ligation) was similar in group S and control group (33% versus 40%), its timing was the same, median 3 days. Left atrial size measured by M mode echocardiography within the first day after S administration did not differ in the two groups, being 130.3 (SD 30.5) per cent of normal values in S versus 128.9 (SD 15.5) per cent in control group (NS). We did not document an increased severity or earlier onset of PDA in premature neonates treated for RDS with bovine surfactant. The authors demonstrate how a paediatric cardiologist may contribute to the treatment of these patients.