Surfactant use in late preterm infants

Specific recommendations on surfactant administration in late preterm (LPT) infants with pulmonary disease are lacking. We performed an online-based, nationwide survey amongst all (n = 102) Belgian neonatologists to identify the use of surfactant in LPT infants suffering from several respiratory pathologies. The survey used clearly defined clinical cases and resulted in a 86% response rate. Neonatologists adhere to the 200 mg/kg initial surfactant dosing scheme. Surfactant is widely used in respiratory distress syndrome (70.1%), but there is less unanimity on its use in meconium aspiration syndrome (58.0%), transient tachypnoea of the newborn (30.6%), congenital pneumonia (27.2%) and congenital diaphragmatic hernia (8.6%). Respondents adhere to the European guideline of a timely referral to a newborn intensive care unit (non-invasive ventilation and FiO2 > 0.30 at 12 h of age), in order to minimise the risk of deterioration. Conclusion: We demonstrate a wide variety in the use of surfactant within LPT infants. The majority of Belgian neonatologists therefore urge for an investment in multi-centre trials on surfactant administration in LPT infants, in order to create an evidence-based practice as well as to reduce the strain on health care budgets. Trial registration: https://clinicaltrials.govWhat is Known:• Any late preterm (LPT) infant with respiratory distress needs a timely referral to a neonatal intensive care unit in case of non-invasive ventilation and FiO2> 0.30 at 12 h of life, in order to minimise the risk of acute deterioration as well as chronic lung disease.• Any modest increase in morbidity in the sizeable group of LPT infants exerts a significant strain on health care budgets.What is New:• We report the attitudes and opinions of Belgian neonatologists about the use of surfactant in LPT infants suffering from several respiratory diseases.• Our survey demonstrates a significant variability in practice between neonatologists during treatment of respiratory pathologies in LPT infants. This highlights an urgent need for univocal therapeutic lines.