Surfactant phosphatidylcholine pool size in human neonates with congenital diaphragmatic hernia requiring ECMO.
OBJECTIVE
We measured surfactant phosphatidylcholine (PC) pool size and half-life in human congenital diaphragmatic hernia (CDH) patients who required extracorporeal membrane oxygenation (ECMO). Study design Surfactant PC pool size and half-life were measured by endotracheal administration of deuterium-labeled dipalmitoylphosphatidylcholine in 8 neonates with CDH on ECMO (CDH-ECMO), in 7 neonates with meconium aspiration syndrome on ECMO (MAS-ECMO), and in 6 ventilated infants (NON-ECMO).


RESULTS
Lung PC pool size in the CDH-ECMO group was 73 +/- 17 mg/kg (mean +/- SEM), which was not significantly different from the MAS-ECMO (50 +/- 18 mg/kg) and the NON-ECMO group (69 +/- 38 mg/kg). Surfactant PC concentration in tracheal aspirates was not different between groups (~6 mg/mL). However, the percentage of palmitic acid in surfactant PC was significantly lower in the MAS-ECMO (56.3%) and the NON-ECMO (55.8%) group compared with the CDH-ECMO (67.6%) group. Surfactant PC half-life (~24 hours) was not different between the groups. A correlation was found between the surfactant PC half-life and the duration of ECMO.


CONCLUSIONS
These data show no decreased surfactant PC pool size in high risk CDH patients who require ECMO. A shorter half-life of surfactant PC, indicating a faster turnover, may result in a faster improvement of the pulmonary condition during ECMO.
Janssen
Daphne J M T
DJ
Department of Pediatrics/Neonatology, Sophia Children's Hospital/Erasmus University Rotterdam, The Netherlands.
Tibboel
Dick
D
Carnielli
Virgilio P
VP
van Emmen
Esther
E
Luijendijk
Ingrid H T
IH
Darcos Wattimena
J L
JL
Zimmermann
Luc J I
LJ
D015060:1,2-Dipalmitoylphosphatidylcholine; D003903:Deuterium; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006207:Half-Life; D006548:Hernia, Diaphragmatic / Q000150:complications / Q000378:metabolism*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007553:Isotope Labeling; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000378:metabolism / Q000628:therapy; D010713:Phosphatidylcholines / Q000032:analysis*; D011663:Pulmonary Surfactants / Q000737:chemistry; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy
D010713:Phosphatidylcholines; D011663:Pulmonary Surfactants; D015060:1,2-Dipalmitoylphosphatidylcholine; D003903:Deuterium