In Reply.—We appreciate Dr Langkamp's concern that the widespread use of surfactant-replacement therapy among very-low-birth-weight infants with surfactant deficiency might result in an exchange of increased neurodevelopmental morbidity for decreased mortality caused by respiratory distress syndrome. Although a larger patient population would be ideal to exclude a type II error conclusively, our follow-up data, based on a randomized, controlled trial of human surfactant replacement, did not indicate substantial differences in major neurologic or developmental sequelae, such as cerebral palsy or severe mental retardation, between surfactant recipients and placebo-treated infants receiving conventional ventilation. We cannot yet exclude differences between the two groups in later sequelae, such as communication disorder, attention-deficit disorder, perceptual-motor abnormalities, or learning disability. While a 100% follow-up rate is desirable, this is difficult to accomplish in most regions of the United States given family mobility, high frequency of low socioeconomic status, and the lack of universal access to health
VAUCHER YE. Assessment of Neurodevelopmental Outcome in Surfactant-Replacement Therapy-Reply. Am J Dis Child. 1989;143(7):763. doi:10.1001/archpedi.1989.02150190013004
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