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The selection of infants for surfactant replacement therapy under conditions of limited financial resources


DE Ballot
AD Rothberg
VA Davies

Abstract

The cost of surfactant replacement therapy (SRT) will restrict its use under conditions of limited health resources. Before the local advent of SAT, infants ventilated for hyaline membrane disease (HMD) had an overall survival rate of 87% and an incidence of bronchopulmonary dysplasia of 6,4%. This, together with the cost of SAT, prompted a study to identify those infants who would benefit the most from SAT. Twenty-two infants assessed as having severe HMD were randomised to receive SRT at 3 - 4 hours (9) or at 6 - 8 hours (13) after birth. Two infants (15%) in the latter group did not require SRT. The outcome of these two groups was the s;ame. Of 56 infants assessed as having moderate HMD, only 24 (43%) qualified for SRT from 6 hours of age, The outcome of the SAT and non-SRT infants was comparable. The group of infants with moderate HMD had a significantly better outcome than those with severe HMD. A limited period of observation to assess the severity of illness did not compromise outcome in this group of 78 infants with moderate to severe HMD.

S Afr Med J 1995; 85: 640-643

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eISSN: 2078-5135
print ISSN: 0256-9574