title: A Noninvasive Surfactant Adsorption Test Predicting the Need for Surfactant Therapy in Preterm Infants Treated with Continuous Positive Airway Pressure.
abstract: To determine the diagnostic accuracy of the surfactant adsorption test (SAT) as a predictor for the need for surfactant replacement therapy in neonates with respiratory distress syndrome (RDS).
  
  
  
  Amniotic fluid samples were collected from 41 preterm neonates with RDS treated with continuous positive airway pressure (CPAP) and 15 healthy control term neonates. Purified porcine surfactant served as a further control. Lamellar bodies and lung ultrasound score were also measured in a subset of the neonates treated with CPAP. Surfactant was administered according to the European guidelines, and clinical data were collected prospectively. Surfactant activity was measured as adsorption at the air/liquid interface and given in relative fluorescent units (RFU).
  
  
  
  Surfactant activity differed among native porcine surfactant (median, 4863 RFU; IQR, 4405-5081 RFU), healthy term neonates (median, 2680 RFU; IQR, 2069-3050 RFU), and preterm neonates with RDS (median, 442 RFU; IQR, 92-920 RFU; P <.0001). The neonates who failed CPAP had lower surfactant activity compared with those who did not fail CPAP (median, 92 RFU; IQR, 0-315 RFU vs 749 RFU; IQR, 360-974 RFU; P = .0002). Differences between groups were more evident beyond 20-30 minutes of fluorescence; the 30-minute time point showed the highest area under the curve (0.84; P <.001) and the best cutoff level (170 RFU; specificity, 72%; sensitivity, 96%) for the prediction of CPAP failure. Surfactant activity at 30 minutes was significantly correlated with lamellar bodies (r = 0.51, P = .006) and lung ultrasound score (r = -0.39, P = .013).
  
  
  
  This technique has the potential to be developed into a fast, simple-to-interpret clinical test. The SAT can reliably identify preterm infants with subsequent CPAP failure and shows promise as a screening test for surfactant replacement in preterm neonates.
authors.affiliation: Department of Biochemistry and Molecular Biology, Faculty of Biology, and Research Institut Hospital 12 de Octubre, Complutense University, Madrid, Spain; Clinical Molecular Biology Laboratory, Department of Clinical Molecular Diagnostics, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Autilio
authors.affiliation: Department of Biochemistry and Molecular Biology, Faculty of Biology, and Research Institut Hospital 12 de Octubre, Complutense University, Madrid, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Echaide
authors.affiliation: Division of Obstetrics and Gynecology, A. Beclere Medical Center, South Paris University Hospitals, APHP, Paris, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Benachi
authors.affiliation: Division of Hematology, A. Beclere Medical Center, South Paris University Hospitals, Assistance Publique-Hopitaux de Paris, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Marfaing-Koka
authors.affiliation: Clinical Molecular Biology Laboratory, Department of Clinical Molecular Diagnostics, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Ettore D
authors.initials: ED
authors.lastname: Capoluongo
authors.affiliation: Department of Biochemistry and Molecular Biology, Faculty of Biology, and Research Institut Hospital 12 de Octubre, Complutense University, Madrid, Spain. Electronic address: jperezgil@bio.ucm.es.
authors.forename: Jesús
authors.initials: J
authors.lastname: Pérez-Gil
authors.affiliation: Division of Pediatrics and Neonatal Critical Care, A. Beclere Medical Center, South Paris University Hospitals, APHP, Paris, France.
authors.forename: Daniele
authors.initials: D
authors.lastname: De Luca
mesh_terms: D000327:Adsorption; D000653:Amniotic Fluid; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012372:ROC Curve; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis* / Q000628:therapy; D013501:Surface-Active Agents
chemical_list: D011663:Pulmonary Surfactants; D013501:Surface-Active Agents
keywords: CPAP; NRDS; amniotic fluid; lamellar bodies; pulmonary surfactant; surface tension