Surfactant treatment of full-term newborns with respiratory failure.
Surfactant inactivation has been shown to be a significant factor in animal models of lung injury and may also be important in some forms of respiratory failure in full-term newborns. Fourteen full-term newborns with respiratory failure associated with pneumonia (7 patients) and meconium aspiration syndrome (7 patients) were treated with 90 mg/kg of a calf lung surfactant extract, given intratracheally up to every 6 hours for a maximum of four doses. The group mean fraction of inspired oxygen (FI02) before treatment was 0.99 +/- 0.01 SEM, and the mean airway pressure (MAP) was 14.6 +/- 1.0 cm H2O. Patients showed significant improvement in oxygenation after initial surfactant treatment, with the arterial-alveolar oxygenation ratio (a/A ratio) rising from 0.09 +/- 0.01 before surfactant treatment to 0.22 +/- 0.05 by 15 minutes (P = .03) and remaining improved for 6 hours. The oxygenation index, incorporating MAP as well as oxygen variables, also improved significantly from 26.2 +/- 3.1 to 11.2 +/- 1.7 at 15 minutes (P less than .001), with improvement sustained for more than 6 hours. Chest radiographs were blindly scored from 0 (normal) to 5 (severe opacification), and these improved with marginal significance after initial surfactant treatment (from 2.9 +/- 0.2 to 2.5 +/- 0.2, P = .05).(ABSTRACT TRUNCATED AT 250 WORDS)
Auten
R L
RL
Department of Pediatrics (Neonatology), University of Rochester School of Medicine, New York 14642.
Notter
R H
RH
Kendig
J W
JW
Davis
J M
JM
Shapiro
D L
DL
D006801:Humans; D007231:Infant, Newborn; D008471:Meconium Aspiration Syndrome / Q000150:complications; D010100:Oxygen / Q000097:blood; D010865:Pilot Projects; D011014:Pneumonia / Q000150:complications; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015996:Survival Rate
D011663:Pulmonary Surfactants; D010100:Oxygen