Surfactant Use for Premature Infants with Respiratory Distress Syndrome in Three New York City Hospitals: Discordance of Practice from a Community Clinician Consensus Standard

OBJECTIVES: To assess concordance with a locally developed standard of care for premature infants with respiratory distress syndrome (RDS) for whom the standard recommends surfactant treatment within two hours of birth, and to examine the association between clinical, demographic, and hospital characteristics with discordance from the standard. STUDY DESIGN: Retrospective cohort study of 773 infants weighing ≤ 1750 grams born in any of three New York City hospitals between 1999 and 2002. RESULTS: 227 of the 773 infants (29%) met criteria for treatment according to the standard. Of these, 37% received surfactant by two hours. By four hours, 70% of infants who met the standard received surfactant. White infants were more likely to receive surfactant by 4 hours (85%) than African American (61%) or Latino infants (67%). Multivariable logistic regression revealed significant odds ratios predicting discordance from the relaxed criteria (4 hours) for: African American race (4.10, 95% CI 1.30–13.00), 100 grams of birth weight (OR of 1.22, 95% CI 1.10–1.34), and hospital of birth. CONCLUSION: Many infants with RDS failed to receive surfactant replacement therapy at 2 and 4 hours after birth. African Americans and those born larger were less likely to receive surfactant. If these data can be generalized, there is a large opportunity to reduce infant morbidity from RDS and to reduce racial/ethnic disparities in birth outcomes by increasing the rate and speed with which surfactant is delivered to these infants.