Respiratory distress is common in Late Preterm (LP, 34+0–36+6 weeks of gestation) and Early Term (ET, 37+0–38+6 weeks of gestation) infants and childhood respiratory outcomes are worse than for full term infants. The commonest reason for neonatal unit (NNU) admission is respiratory distress syndrome due to surfactant deficiency. No evidence-based guidance exists for early respiratory management in this population and clinical practice varies widely. Many infants receive non-invasive respiratory support after birth. Some recover spontaneously but others go on to need mechanical ventilation and prolonged intensive care. It is difficult to predict which infants will deteriorate. Some clinicians use surfactant early to prevent respiratory deterioration; others choose to wait and give only if needed. The best strategy to prevent severe respiratory disease and reduce adverse long-term respiratory outcomes is not known.
To investigate whether, in LP and ET infants with respiratory distress, early use of surfactant versus expectant management results in shorter duration of hospital stay and reduced disease severity.
Infants born between born between 34+0 and 38+6 weeks of gestation with respiratory distress and for whom a clinical decision has been made to provide non-invasive respiratory support.
Born at 34+0–38+6 weeks of gestation
≤ 24 hours old
Respiratory distress defined as;
FiO2 ≥ 0.3 and < 0.45 needed to maintain SaO2 ≥ 92%, or
Clinically significant work of breathing, regardless of FiO2
Clinical decision to provide non-invasive respiratory support
Written parental informed consent
Major structural or chromosomal abnormality
No realistic prospect of survival
Prior intubation and/or surfactant administration
Known or suspected hypoxic ischaemic encephalopathy
Congenital abnormality of the upper or lower respiratory tract
Known or suspected neuromuscular disorder
Infants will be randomised as soon as possible after consent using a 1:1 allocation ratio to either: