Surfactant use for premature infants with respiratory distress syndrome in three New York city hospitals: discordance of practice from a community clinician consensus standard

Objective: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 2 h 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 g born in any of the three new york city hospitals between 1999 and 2002.result:227 of the 773 infants (29%) met criteria for treatment according to the standard. of these, 37% received surfactant by 2 h. by 4 h, 70% of infants who met the standard received surfactant. white infants were more likely to receive surfactant by 4 h (85%) than african american (61%) or latino infants (67%). multivariable logistic regression revealed significant odds ratios predicting discordance from the relaxed criteria (4 h) for african american race (4.10, 95% confidence interval: 1.30 to 13.00), 100 g of birth weight (odds ratio: 1.22, 95% confidence interval: 1.10 to 1.34), and hospital of birth.conclusion:many infants with rds failed to receive surfactant replacement therapy at 2 and 4 h 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.