{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T22:15:34Z","timestamp":1784758534284,"version":"3.55.0"},"reference-count":25,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,1,1]]},"abstract":"<jats:p>BACKGROUND. Chronic lung disease is one of the most frequent and serious complications of premature birth. Because mechanical ventilation is a major risk factor for chronic lung disease, the early application of nasal continuous positive airway pressure has been used as a strategy for avoiding mechanical ventilation in premature infants. Surfactant therapy improves the short-term respiratory status of premature infants, but its use is traditionally limited to infants being mechanically ventilated. Administration of very early surfactant during a brief period of intubation to infants treated with nasal continuous positive airway pressure may improve their outcome and further decrease the need for mechanical ventilation.<\/jats:p><jats:p>OBJECTIVE. Our goal was to determine if very early surfactant therapy without mandatory ventilation improves outcome and decreases the need for mechanical ventilation when used in very premature infants treated with nasal continuous positive airway pressure soon after birth.<\/jats:p><jats:p>DESIGN\/METHODS. Eight centers in Colombia participated in this randomized, controlled trial. Infants born between 27 and 31 weeks\u2019 gestation with evidence of respiratory distress and treated with supplemental oxygen in the delivery room were randomly assigned within the first hour of life to intubation, very early surfactant, extubation, and nasal continuous positive airway pressure (treatment group) or nasal continuous airway pressure alone (control group). The primary outcome was the need for subsequent mechanical ventilation using predefined criteria.<\/jats:p><jats:p>RESULTS. From January 1, 2004, to December 31, 2006, 279 infants were randomly assigned, 141 to the treatment group and 138 to the control group. The need for mechanical ventilation was lower in the treatment group (26%) compared with the control group (39%). Air-leak syndrome occurred less frequently in the treatment group (2%) compared with the control group (9%). The percentage of patients receiving surfactant after the first hour of life was also significantly less in the treatment group (12%) compared with the control group (26%). The incidence of chronic lung disease (oxygen treatment at 36 weeks\u2019 postmenstrual age) was 49% in the treatment group compared with 59% in the control group. All other outcomes, including mortality, intraventricular hemorrhage, and periventricular leukomalacia were similar between the groups.<\/jats:p><jats:p>CONCLUSIONS. In premature infants treated with nasal continuous positive airway pressure early after birth, the addition of very early surfactant therapy without mandatory ventilation decreased the need for subsequent mechanical ventilation, decreased the incidence of air-leak syndrome, and seemed to be safe. Reduction in the need for mechanical ventilation is an important outcome when medical resources are limited and may result in less chronic lung disease in both developed and developing countries.<\/jats:p>","DOI":"10.1542\/peds.2007-3501","type":"journal-article","created":{"date-parts":[[2008,12,29]],"date-time":"2008-12-29T15:58:03Z","timestamp":1230566283000},"page":"137-142","source":"Crossref","is-referenced-by-count":163,"title":["Very Early Surfactant Without Mandatory Ventilation in Premature Infants Treated With Early Continuous Positive Airway Pressure: A Randomized, Controlled Trial"],"prefix":"10.1542","volume":"123","author":[{"given":"Mario Augusto","family":"Rojas","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Vanderbilt University, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Manuel","family":"Lozano","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Biostatistics, Universidad Javeriana, Bogota\u0301, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Ximena","family":"Rojas","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Biostatistics, Universidad Javeriana, Bogota\u0301, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Laughon","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl Lewis","family":"Bose","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin Alonso","family":"Rondon","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Biostatistics, Universidad Javeriana, Bogota\u0301, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Charry","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Biostatistics, Universidad Javeriana, Bogota\u0301, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime Alberto","family":"Bastidas","sequence":"additional","affiliation":[{"name":"Cli\u0301nica Los Farallones\/Remedios, Cali, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Alfonso","family":"Perez","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital Universitario de Santander, Bucaramanga, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Rojas","sequence":"additional","affiliation":[{"name":"Policli\u0301nico del Olaya, Bogota\u0301, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"Ovalle","sequence":"additional","affiliation":[{"name":"Saludcoop, Bogota\u0301, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luz Astrid","family":"Celis","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital Universitario Simo\u0301n Bolivar, Bogota\u0301, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Garcia-Harker","sequence":"additional","affiliation":[{"name":"Cli\u0301nica San Luis, Bucaramanga, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha Lucia","family":"Jaramillo","sequence":"additional","affiliation":[{"name":"Fundacio\u0301n Valle de Lili, Cali, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Colombian Neonatal Research Network","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2009,1,1]]},"reference":[{"key":"2021120905102956200_R1","doi-asserted-by":"crossref","unstructured":"Parker RA, Lindstrom DP, Cotton RB. Improved survival accounts for most, but not all, of the increase in bronchopulmonary dysplasia. Pediatrics.\u20081992;90(5):663\u2013668","DOI":"10.1542\/peds.90.5.663"},{"key":"2021120905102956200_R2","doi-asserted-by":"crossref","unstructured":"Bancalari E, del Moral T. Bronchopulmonary dysplasia and surfactant. Biol Neonate.\u20082001;80(suppl 1):7\u201313","DOI":"10.1159\/000047170"},{"key":"2021120905102956200_R3","doi-asserted-by":"crossref","unstructured":"Bruce MC, Schuyler M, Martin RJ, Starcher BC, Tomashefski JF Jr, Werdig KE. Risk factors for the degradation of lung elastic fibers in the ventilated neonate: implications for impaired lung development in bronchopulmonary dysplasia. Am Rev Respir Dis.\u20081992;146(1):204\u2013212","DOI":"10.1164\/ajrccm\/146.1.204"},{"key":"2021120905102956200_R4","doi-asserted-by":"crossref","unstructured":"Avery ME, Tooley WH, Keller JB, et al. Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. 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Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. N Engl J Med.\u20081994;331(16):1051\u20131055","DOI":"10.1056\/NEJM199410203311603"},{"key":"2021120905102956200_R15","doi-asserted-by":"crossref","unstructured":"Verder H, Albertsen P, Ebbeson F, et al. Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks\u2019 gestation. Pediatrics.\u20081999;103(2). Available at: www.pediatrics.org\/cgi\/content\/full\/103\/2\/e24","DOI":"10.1542\/peds.103.2.e24"},{"key":"2021120905102956200_R16","doi-asserted-by":"crossref","unstructured":"Reininger A, Khalak R, Kendig JW, et al. Surfactant administration by transient intubation in infants 29 to 25 weeks\u2019 gestation with respiratory distress syndrome decreases the likelihood of later mechanical ventilation: a randomized control trial. J Perinatol.\u20082005;25(11):703\u2013708","DOI":"10.1038\/sj.jp.7211381"},{"key":"2021120905102956200_R17","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics, Committee on Fetus and Newborn. Levels of neonatal care [published correction appears in Pediatrics. 2005;115(4):1118]. Pediatrics.\u20082004;114(5):1341\u20131347","DOI":"10.1542\/peds.2004-1697"},{"key":"2021120905102956200_R18","unstructured":"Kattwinkel J, ed. Textbook of Neonatal Resuscitation. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics and American Heart Association; 2000"},{"key":"2021120905102956200_R19","doi-asserted-by":"crossref","unstructured":"Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weight less than 1500 grams. 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