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Haemodynamic changes after delivery room surfactant administration to very low birth weight infants
  1. Arvind Sehgal1,2,
  2. Wendy Mak1,2,
  3. Michael Dunn2,3,
  4. Edmond Kelly2,4,
  5. Hilary Whyte1,2,
  6. B McCrindle2,5,
  7. Patrick J McNamara1,2,6
  1. 1Division of Neonatology, The Hospital for Sick Children, Toronto, Canada
  2. 2Department of Paediatrics, University of Toronto, Toronto, Canada
  3. 3Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Canada
  4. 4Department of Paediatrics, Mount Sinai Hospital, Toronto, Canada
  5. 5Division of Cardiology, The Hospital for Sick Children, Toronto, Canada
  6. 6Division of Physiology and Experimental Medicine Program, The Hospital for Sick Children, Toronto, Canada
  1. Correspondence to Dr Patrick J McNamara, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada; patrick.mcnamara{at}


Introduction Surfactant replacement therapy (SRT) reduces respiratory morbidity and mortality in premature infants. The goal of this study was to characterise the effects of delivery room SRT on the ductus arteriosus and early neonatal haemodynamics.

Methods A prospective observational study was conducted in preterm infants of less than 32 weeks' gestation who received SRT within 30 min of birth. Serial echocardiography was performed before and after SRT. Characteristics of the ductus arteriosus, myocardial performance, right ventricular output (RVO) and left ventricular output (LVO) and the ratio of RVO:LVO were measured.

Results Sixteen babies, born at 28.3±1.3 weeks' gestation and weighing 1289±224 g, were studied. SRT was associated with an improvement in the arterial oxygen tension:fractional inspired oxygen ratio (p<0.001), increased systolic and decreased diastolic arterial pressure (p<0.05). The ductus arteriosus was patent in all and transductal flow was unrestrictive and exclusively left-to-right after SRT. An increase in transductal diameter (p<0.001), left atrium:aortic ratio (p=0.006) but a decrease in left ventricular end-diastolic dimension (p=0.02) was identified.

Conclusion SRT administration was followed by increased RVO but decreased LVO, resulting in an increased RVO:LVO ratio and an increase in ductal size. Delivery room administration of SRT is associated with major haemodynamic changes. The impact of these changes needs prospective evaluation.

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  • Funding None.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the research ethics board at each participating site, Hospital for Sick Children, Mount Sinai Hospital and Sunnybrook Health Sciences centre.

  • Patient consent Obtained from the parents.

  • Provenance and peer review Not commissioned; not externally peer reviewed.