{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T22:09:06Z","timestamp":1769638146157,"version":"3.49.0"},"reference-count":25,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2000,9,1]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>To determine whether use of the click test, a rapid bedside test of surfactant function, results in earlier and more appropriate surfactant administration in ventilated preterm infants than does usual early rescue treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design.<\/jats:title><jats:p>Ventilated preterm infants (n = 126) with inspired oxygen \u226525% and mean airway pressure \u22657 cm H2O were randomized in gestational strata (&amp;lt;28 weeks and 28\u201336 weeks) to have surfactant therapy determined by the click test or by usual clinical and chest radiograph criteria. The treatment group had the click test performed on a tracheal aspirate as soon as possible after intubation and, if negative or equivocal (surfactant deficient), surfactant was given. The control group had surfactant given as soon as possible based on clinical and chest radiograph diagnoses of respiratory distress syndrome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>In infants of &amp;lt;28 weeks' gestation, use of the click test resulted in significantly earlier surfactant therapy (median time: 50 vs 159 minutes) and a reduction in the number of infants receiving surfactant (48% vs 79%). In infants of 28 to 36 weeks' gestation, there was no difference in time to surfactant (median time: 300 vs 268 minutes) or in the number of infants receiving surfactant. Neonatal morbidity and mortality were similar in click test and control groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions.<\/jats:title><jats:p>Use of the click test in ventilated, extremely premature infants results in significantly earlier and more appropriately targeted administration of surfactant than does early rescue therapy based on clinical and radiograph criteria. A randomized trial of targeted early rescue surfactant therapy versus prophylactic surfactant therapy in infants of &amp;lt;28 weeks' gestation is warranted. The click test has the potential to improve clinical outcomes and reduce costs.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.106.3.e30","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:50:41Z","timestamp":1092441041000},"page":"e30-e30","source":"Crossref","is-referenced-by-count":21,"title":["Targeted Early Rescue Surfactant in Ventilated Preterm Infants Using the Click Test"],"prefix":"10.1542","volume":"106","author":[{"given":"David A.","family":"Osborn","sequence":"first","affiliation":[{"name":"From the Department of Neonatology, Royal Prince Alfred Hospital; and the"},{"name":"Department of Obstetrics and Gynaecology and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather E.","family":"Jeffery","sequence":"additional","affiliation":[{"name":"From the Department of Neonatology, Royal Prince Alfred Hospital; and the"},{"name":"Department of Obstetrics and Gynaecology and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandie L.","family":"Bredemeyer","sequence":"additional","affiliation":[{"name":"From the Department of Neonatology, Royal Prince Alfred Hospital; and the"},{"name":"Faculty of Nursing, University of Sydney, Camperdown, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan M.","family":"Polverino","sequence":"additional","affiliation":[{"name":"From the Department of Neonatology, Royal Prince Alfred Hospital; and the"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shelley","family":"Reid","sequence":"additional","affiliation":[{"name":"From the Department of Neonatology, Royal Prince Alfred Hospital; and the"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2000,9,1]]},"reference":[{"key":"2021121003235184600_B1","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1016\/0140-6736(92)92557-V","article-title":"Early versus delayed neonatal administration of a synthetic surfactant: the judgement of OSIRIS.","volume":"340","author":"The OSIRIS Collaborative Group","year":"1992","journal-title":"Lancet"},{"key":"2021121003235184600_B2","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/0378-3782(92)90164-C","article-title":"A prospective, randomized trial of early versus late administration of a single dose of surfactant TA.","volume":"29","author":"Konishi","year":"1992","journal-title":"Early Hum Dev"},{"key":"2021121003235184600_B3"},{"key":"2021121003235184600_B4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1515\/jpme.1996.24.6.609","article-title":"Prophylaxis of respiratory distress syndrome by treatment with modified porcine surfactant at birth: a multicentre prospective randomized trial.","volume":"24","author":"Bevilacqua","year":"1996","journal-title":"J Perinat Med"},{"key":"2021121003235184600_B5","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1542\/peds.87.3.377","article-title":"Bovine surfactant replacement therapy in neonates of less than 30 weeks' gestation: a randomized controlled trial of prophylaxis vs treatment.","volume":"87","author":"Dunn","year":"1991","journal-title":"Pediatrics"},{"key":"2021121003235184600_B6","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1542\/peds.92.6.768","article-title":"Comparison of prophylaxis and rescue treatment with Curosurf in neonates less than 30 weeks gestation: a randomized trial.","volume":"92","author":"Egberts","year":"1993","journal-title":"Pediatrics"},{"key":"2021121003235184600_B7","first-page":"90","article-title":"Prophylactic administration of calf lung surfactant extract is more effective than early treatment of respiratory distress syndrome in neonates of 29 through 32 weeks' gestation.","volume":"92","author":"Kattwinkel","year":"1993","journal-title":"Pediatrics"},{"key":"2021121003235184600_B8","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1056\/NEJM199103283241301","article-title":"A comparison of surfactant as immediate prophylaxis and as rescue therapy in newborns of less than 30 weeks' gestation.","volume":"324","author":"Kendig","year":"1991","journal-title":"N Engl J Med"},{"key":"2021121003235184600_B9","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/S0022-3476(05)83387-6","article-title":"Randomized, placebo-controlled trial of human surfactant given at birth vs rescue administration in very low birth weight infants with lung immaturity.","volume":"118","author":"Merritt","year":"1991","journal-title":"J Pediatr"},{"key":"2021121003235184600_B10","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1111\/j.1651-2227.1995.tb13792.x","article-title":"Porcine surfactant replacement therapy in newborns of 25\u201331 weeks' gestation: a randomized multicentre trial of prophylaxis versus rescue with multiple low doses.","volume":"84","author":"Walti","year":"1995","journal-title":"Acta Paediatr"},{"key":"2021121003235184600_B11"},{"key":"2021121003235184600_B12","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1002\/ppul.1950170608","article-title":"\u201cClick test\u201d: rapid diagnosis of the respiratory distress syndrome.","volume":"17","author":"Skelton","year":"1994","journal-title":"Pediatr Pulmonol"},{"key":"2021121003235184600_B13","first-page":"104","article-title":"Evaluation of bubble clicking in gastric aspirate in the newborn.","volume":"19","author":"Todd","year":"1983","journal-title":"Aust Paediatr J"},{"key":"2021121003235184600_B14","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1007\/BF02072494","article-title":"Stable microbubble test for predicting the risk of respiratory distress syndrome. 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