The goal of this study was to determine the effects of antenatal corticosteroids and surfactant replacement on the severity and frequency of Respiratory Distress Syndrome (RDS) in a cohort of premature infants born in Sarajevo, Bosnia and Herzegovina, from 2005 to 2007. The cohort consisted of 172 premature neonates with estimated gestational age between 26 and 34 weeks. Babies with IUGR, babies of diabetic mothers and babies with major congenital defects were excluded. Out of 172 neonates, 80 were treated antenatally with corticosteroids (single course of dexamethasone) and 92/172 were not. There was no statistical difference (p>0,5) in average gestational age (31,2 vs. 31,0 GW) and male/female ratio between investigated groups; there were significantly more male patients (p<0,05) in both groups. Frequency of RDS was significantly lower in the corticosteroid group (24/80) in relation to the control group (54/92) (p<0,001). Severe RDS was significantly (p<0,01) more frequent in the control group 34/53 (62,96%) then in the corticosteroid group 6/24 (25,0%). Bovine surfactant (Survanta) was given as a rescue therapy to 78 babies with clinical and radiological signs of RDS who required FiO2>0,40 and mechanical ventilation. Early surfactant administration within six hours after birth appeared to be effective at reducing mortality then later surfactant administration (p<0,005). In the group of babies requiring FiO2> or =0,6 at the time of surfactant replacement, the mortality rate was significantly higher (p<0,05). In conclusion, we confirm the efficacy of antenatal corticosteroid treatment and early surfactant treatment in a cohort of premature infants born in Sarajevo.

Intraventricular-periventricular hemorrhage (IVH-PVH) is the most frequent type of intracranial hemorrhage in premature infants and the major cause of neurodevelopmental disabilities in children too. The objective of this work is to evaluate the effects of prenatal corticosteroid treatment on the incidence of IVH-PVH in premature infants. The study enrolled 163 prematures of 26-34 weeks’ gestation. They have been divided into two groups: the experimental group (80/163), who have been treated with corticosteroids prenatally and control group (83/163), who have not received such treatment. There is statistically significant difference in IVH-PVH incidence between the experimental group (18/80) and control group (32/83) (χ 2  =5,616, p<0,05). There is no statistically significant difference in Apgar score after 5 minutes between the experimental group and control group of IVH-PVH prematures, t= 0,121. There is no statistically significant difference in mean gestation age between the experimental group (30,74 weeks) and control group (29,97 weeks) of IVH-PVH prematures, t= 1,299. There is no statistically significant difference in mean birth weight between the experimental group (1479,44 grams) and control group (1379,37 grams) of IVH-PVH prematures, t= 0,913. Antenatal corticosteroid treatment of premature infants reduced the incidence of IVH-PVH significantly. There is no statistically significant difference in Apgar score after 5 minutes, mean gestation age and mean birth weight between the experimental and control group of IVH PVH prematures.

Background. The significant advancement in the treatment of respiratory distress syndrome can be attributed to prenatal identification of high risk pregnancies, prevention of illness through antenatal care, prenatal administration of glucocorticoids, advancement in respiratory support and surfactant therapy. These measures resulted in the reduction of mortality and morbidity rates in preterm infants. Patients and methods. We analyzed data of 78 preterm babies with respiratory distress syndrome hospitalized in the NICU of the Pediatric Clinic, KCU Sarajevo. All children included in the study were mechanically ventilated and treated with one or more doses of bovine surfactant (Survanta) as rescue therapy. Surfactant was given to children with clinical and radiological signs of RDS, who required FiO2>0,40. We used the standard procedure of giving surfactant therapy to intubated children in sterile conditions, after we confirmed, by X-ray, correct tube placement. Results. We investigated the clinical efficacy of surfactant in relation to time of administration, O 2 requirement and necessity of one or more doses of surfactant. We found that early treatment with surfactant replacement- within 6 hours of birth- is more effective, and resulted in a significant reduction of mortality rate (p<0,01). Treatment with multiple doses is more effective in comparison to one dose, although there was not a significant difference (p<0,20) between the treated groups. There is a significant difference (p<0,01) between groups related to O 2 requirement. In the group of babies which required 60% or more O 2 concentration in inhaled air at the time of surfactant replacement, mortality rate was significantly higher (p<0,01). Conclusion. Our study confirmed the benefits of surfactant therapy in preterm babies with respiratory distress syndrome. We confirmed the advantages of early treatment vs. late treatment, but we could not confirm the obvious advantage of multiple over single doses. So, a reasonable recommendation is to treat the infants as soon as clinical signs of developing respiratory distress appear with an individual dose for each infant.