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Surfactant and GBS Infection
Surfactant Treatment of Neonates with Respiratory Failure and Group B Streptococcal Infection. Herting E, Gefeller O, Land M, et al. Pediatrics 2000; 106 : 957-64.
The study comprised 118 infants with respiratory failure, clinical and/or laboratory signs of acute inflammatory disease, and GBS infection proven by culture results. They were recruited from a database of patients treated with surfactant at 28 neonatology units participating in European multicenter trials (1987-1993) and prospectively from the same units in the following years. The median birth weight of the study group was 1468 grams, and median gestational age was 30 weeks. 31% of study infants weighed > 2 kg. The mean surfactant dose was 142 mg/kg, and Curosurf was the predominant surfactant used (76%). A nonrandomized control group of 236 non-infected infants treated with surfactant for RDS was ,selected from the same database. Within 1 hour of surfactant treatment, the median FIO2 of the study group was reduced from .84 to .50 (p < .01). The incidence of complications in the study group (Mortality: 30%; pneumothorax: 16%; ICH: 42%) was high compared to the infants with RDS.
Comment: In a commentary published in the same issue of Pediatrics, Alan Jobe writes: "The value of the Herting article is to demonstrate clearly that there should be no concerns about treating preterm or term infants with sepsis / pneumonia syndromes with surfactant - the treatment will not hurt, and it will help about 70% of the time". I’m not sure that I agree with this sentiment. Sure, surfactant treatment usually improves gas exchange in GBS-infected babies, though the response was slower and less impressive than that seen in babies with RDS. I’m concerned about the high incidence of mortality and complications in the study group. The 30% mortality rate for the study group seems high, and if you include only those babies with positive blood cultures for GBS (rather than tracheal, gastric or skin cultures) then the mortality rate jumps to 49%. The incidence of CLD, ICH, and pneumothorax was also notable in the study group, especially considering the high median birth weight of these babies. Unfortunately, the study did not include a control group of babies with GBS infection that did not receive surfactant therapy. Until such data is available, we cannot be sure that surfactant treatment did not in fact worsen the outcomes of babies in the study group.
Andrew B. Kairalla MD