Prospective evaluation of surfactant composition in bronchoalveolar lavage fluid of infants with congenital diaphragmatic hernia and of age-matched controls.
OBJECTIVE
Infants with congenital diaphragmatic hernia may have biochemically immature lungs. However, normal lecithin/sphingomyelin ratios and phosphatidylglycerol concentrations have been reported in the amniotic fluid of congenital diaphragmatic hernia patients. We hypothesized that if the lungs of congenital diaphragmatic hernia patients are surfactant deficient, that this condition would be reflected in an altered surfactant composition in the bronchoalveolar lavage fluid compared with that composition in age-matched controls.


METHODS
Prospective, controlled study.


METHODS
Surgical intensive care unit in a Level III pediatric university hospital.


METHODS
Four groups were studied: two groups of congenital diaphragmatic hernia patients (conventionally ventilated, n = 13; treated with extracorporeal membrane oxygenation, n = 5); and two control groups (conventionally ventilated, n = 13; extracorporeal membrane oxygenation, n = 6).


METHODS
Bronchoalveolar lavage, using a blind, standardized technique, was performed in conventionally ventilated congenital diaphragmatic hernia patients, extracorporeal membrane oxygenation-treated congenital diaphragmatic hernia patients, age-matched conventionally ventilated controls without pulmonary abnormalities, and extracorporeal membrane oxygenation-treated infants without congenital diaphragmatic hernia.


RESULTS
The concentrations of different surfactant phospholipids and the fatty acid composition of phosphatidylcholine in bronchoalveolar lavage fluid were measured. No significant differences between the concentrations of phosphatidylcholine and phosphatidylglycerol, and the lecithin/sphingomyelin ratios, were found between the four groups. The fatty acid composition of phosphatidylcholine in conventionally ventilated patients showed a median percentage of palmitic acid within the normal range for age in both groups: 68% in congenital diaphragmatic hernia patients and 73% in controls (p < .001).


CONCLUSIONS
Our findings indicate that the concentrations of different phospholipids are similar in congenital diaphragmatic hernia patients and controls without congenital diaphragmatic hernia. A primary surfactant deficiency is unlikely in infants with congenital diaphragmatic hernia. However, secondary surfactant deficiency after respiratory failure may be involved.
IJsselstijn
H
H
Department of Pediatric Surgery, Erasmus University and University Hospital/Sophia Children's Hospital, Rotterdam, The Netherlands.
Zimmermann
L J
LJ
Bunt
J E
JE
de Jongste
J C
JC
Tibboel
D
D
D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D015199:Extracorporeal Membrane Oxygenation; D005227:Fatty Acids / Q000032:analysis; D006548:Hernia, Diaphragmatic / Q000378:metabolism / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D010713:Phosphatidylcholines / Q000032:analysis / Q000737:chemistry; D010715:Phosphatidylglycerols / Q000032:analysis; D010743:Phospholipids / Q000032:analysis / Q000737:chemistry; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000737:chemistry*; D012121:Respiration, Artificial; D013109:Sphingomyelins / Q000032:analysis
D005227:Fatty Acids; D010713:Phosphatidylcholines; D010715:Phosphatidylglycerols; D010743:Phospholipids; D011663:Pulmonary Surfactants; D013109:Sphingomyelins