> You said
>  < Also, various therapeutic approaches have been around long enough to
> capture longterm outcomes, thus the sad news against surfactant therapy,
> originally hailed as one of the greatest breakthroughs in neonatal
> medicine.>
>
> Could you tell me what the sad news is?

It seems as if there is a higher risk for Grade III or Grade IV
intraventricular hemmorrhage (brain bleeds) when surfactant is used.
These are the bleeds that may lead to cerebral palsy or other long-term
morbidity sequleae for the premie. The exact mechanism for this
association is not exactly known, as far as I know. There is still a use
for surfactant but possibly in far fewer instances than originally hoped
for. There are probably more, but here are 2 references I know of:

Ferrara, TB., Hoekstra, R.E., Couser, R.J., Gaziano, E.P, Calvin S.E.,
Payne, N.R., and Fangman, J.J. (1994). Survival and follow-up of infants
born at 23 to 26 weeks of gestational age: effect of surfactant therapy.
J. Pediat: 124, 119-124

Horbar, J.D., Soll, R.F., Schachinger, MR., et al (1990). A European
multicenter randomized controlled trial of single dose surfactant
therapy for idiopathic respiratory distress syndromes.
Eu. J. Pediati: 149, 41~23

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Katharine West, BSN, MPH
Sherman Oaks, CA