Respiratory mechanics before and after late artificial surfactant rescue.
OBJECTIVE
To assess the effect of late administration of synthetic surfactant (Exosurf) on the ventilatory function of premature infants with hyaline membrane disease (HMD).


METHODS
Prospective non-randomized study in the Neonatal Intensive Care Unit (NICU) of a major referral hospital. The patients included two groups of premature infants with a birthweight between 750 and 2000 g who developed HMD. In group 1 with moderate to severe HMD, 2 x 5 mL/kg doses of Exosurf were given 12 h apart (first dose given at a mean age of 18.7 +/- 3.4 h [mean +/- s.e.m.]). In group 2 with milder HMD, no surfactant was given.


RESULTS
Significant reductions (P < 0.05) in the fraction of inspired oxygen (FIO2) occurred 6 h after surfactant administration (24 h of life) and by 48 h (64 h of life) in group 2. These improvements in gas exchange preceded improvements in passive respiratory compliance which occurred 24 h after surfactant (42 h of life) and by 72 h (88 h of life) in group 2 (P < 0.01). In both groups pulmonary resistance increased and was significant (P < 0.05) by 48 h (66 h of life) in group 1.


CONCLUSIONS
Synthetic surfactant given as late as a mean age 18.7 +/- 3.4 h still improves gas exchange but these early improvements cannot be completely explained by modifications of respiratory compliance.
Todd
D A
DA
Laboratoire de Physiologie, Universite de Bordeaux 2, France.
Choukroun
M L
ML
Fayon
M
M
Kays
C
C
Guénard
H
H
Galpérine
I
I
Demarquez
J L
JL
D000367:Age Factors; D003131:Combined Modality Therapy; D004338:Drug Combinations; D005233:Fatty Alcohols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006819:Hyaline Membrane Disease / Q000188:drug therapy* / Q000503:physiopathology; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D010767:Phosphorylcholine; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012121:Respiration, Artificial; D015656:Respiratory Mechanics / Q000187:drug effects*
D004338:Drug Combinations; D005233:Fatty Alcohols; D011663:Pulmonary Surfactants; D010767:Phosphorylcholine; D011092:Polyethylene Glycols; C047049:dipalmitoylphosphatidylcholine, hexadecanol, tyloxapol drug combination