title: Effects of Two Different Exogenous Surfactant Preparations on Serial Peripheral Perfusion Index and Tissue Carbon Monoxide Measurements in Preterm Infants with Severe Respiratory Distress Syndrome.
abstract: BACKGROUND
  Administration of an exogenous surfactant may affect both ventilatory and hemodynamic parameters in preterm infants with respiratory distress syndrome (RDS). Peripheral perfusion may be expected to be influenced, and serial perfusion index (PI) values may show this effect. Noninvasive transcutaneous carbon monoxide (TCO) monitoring may show RDS severity, oxidative and inflammatory stress, and response to surfactant treatment.
  
  
  METHODS
  This randomized controlled nonblinded study was performed in 30 preterm infants with RDS, treated with poractant alfa (n = 15) or beractant (n = 15); 18 preterm infants without RDS served as a control group. Oxygenation and hemodynamic parameters were recorded and compared through the first 6 hours of treatment. PI and TCO values were measured prior to (Tp), immediately after (T0), and at 5 minutes (T5), 30 minutes (T30), 60 minutes (T60), and 360 minutes (T360) after the bolus surfactant administration. The mean arterial pressure, oxygenation index, pH, and lactate levels were recorded simultaneously.
  
  
  RESULTS
  Both study groups had lower Tp PI and higher Tp TCO levels than controls. Both surfactant preparations improved the PI, TCO, mean arterial pressure, oxygenation index, pH, and lactate levels at the end point of T360. However, the median Tp PI value of 1.3 first decreased to 0.86 at T0 (P < 0.001), and then it increased to 0.99 at T5 (p < 0.001) and to 1.25 at T30 (p = 0.037). The median Tp TCO value of 3 decreased to 2, 1.5, 0, and 0 at T0, T5, T30, and T60, respectively (p < 0.001). PI more quickly recovered to Tp values (30 minutes vs. 60 minutes) and reached the control group values (30 minutes vs. 360 minutes) with beractant compared to that with poractant alfa. TCO recovered to Tp values in both groups at the same time (5 minutes vs. 5 minutes), but reached the control group values more quickly (5 minutes vs. 30 minutes) with poractant alfa than with beractant.
  
  
  CONCLUSIONS
  Patients with RDS had poor perfusion, and PI improved with both surfactant preparations only following a short decline in the 1(st) minute. The expected improvement of PI occurred earlier in the beractant subgroup. TCO declined in both groups, showing lung improvement and decreased oxidative/inflammatory stress, and it was normalized earlier with poractant alfa.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkey.
authors.forename: Demet
authors.initials: D
authors.lastname: Terek
authors.affiliation: Division of Neonatology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkey.
authors.forename: Deniz
authors.initials: D
authors.lastname: Gonulal
authors.affiliation: Division of Neonatology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkey.
authors.forename: Ozge Altun
authors.initials: OA
authors.lastname: Koroglu
authors.affiliation: Division of Neonatology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkey. Electronic address: mehmet.yalaz@ege.edu.tr.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yalaz
authors.affiliation: Division of Neonatology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkey.
authors.forename: Mete
authors.initials: M
authors.lastname: Akisu
authors.affiliation: Division of Neonatology, Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkey.
authors.forename: Nilgun
authors.initials: N
authors.lastname: Kultursay
mesh_terms: D001688:Biological Products / Q000627:therapeutic use; D002248:Carbon Monoxide / Q000032:analysis*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000378:metabolism*; D007235:Infant, Premature, Diseases / Q000628:therapy*; D008297:Male; D010743:Phospholipids / Q000627:therapeutic use; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy* / Q000473:pathology; D013501:Surface-Active Agents
chemical_list: D001688:Biological Products; D010743:Phospholipids; D011663:Pulmonary Surfactants; D013501:Surface-Active Agents; D002248:Carbon Monoxide; C068291:poractant alfa; C072197:beractant
keywords: newborn; perfusion index; respiratory distress syndrome; surfactant; transcutaneous carbon monoxide