Early surfactant replacement guided by lung ultrasound in preterm newborns with RDS: the ULTRASURF randomised controlled trial

Rodriguez-Fanjul, Javier; Jordan, I.; Balaguer, M.; Batista-Muñoz, A.; Ramon, M.; Bobillo-Perez, S.

This study aimed to investigate whether using lung ultrasound (LUS) scores in premature newborns with respiratory distress syndrome (RDS) allows for earlier surfactant therapy (within the first 3 h of life) than using FiO(2) criteria. This was a randomised, non-blinded clinical trial conducted in a neonatal intensive care unit. The inclusion criteria were newborns with a gestational age of ≤ 32 weeks and RDS. Patients meeting the inclusion criteria were randomly assigned to two groups: the ultrasound group, administered surfactant based on LUS score and/or FiO(2) threshold, and the control group, guided by FiO(2) only. Fifty-six patients were included. The ultrasound group received surfactant earlier (1 h of life vs. 6 h, p < 0.001), with lower FiO(2) (25% vs. 30%, p = 0.016) and lower CO(2) (48 vs. 54, p = 0.011). After surfactant treatment, newborns in the ultrasound group presented a greater SpO(2) (p = 0.001) and SpO(2)/FiO(2) ratio (p = 0.012). Conclusions: LUS score allowed an earlier surfactant therapy, reduced oxygen exposure early in life and a better oxygenation after the treatment. This early surfactant replacement may lead to reduced oxygen exposure.