Long-term pulmonary consequences of respiratory distress syndrome in preterm infants treated with exogenous surfactant

• Published in: The Journal of pediatrics Vol. 122; no. 3; pp. 446 - 452
• Main Authors: Abbasi, Soraya, Bhutani, Vinod K., Gerdes, Jeffrey S.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.03.1993; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Drug Combinations; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Fatty Alcohols - therapeutic use; Female; Follow-Up Studies; Humans; Infant, Newborn; Infant, Premature; Intensive care medicine; Lung Diseases - etiology; Male; Medical sciences; Phosphorylcholine; Polyethylene Glycols - therapeutic use; Pulmonary Surfactants - therapeutic use; Respiratory Distress Syndrome, Newborn - complications; Respiratory Distress Syndrome, Newborn - drug therapy; Respiratory Distress Syndrome, Newborn - physiopathology; Respiratory Function Tests; Treatment Outcome; Human; Premature; Replacement therapy; Prognosis; Respiratory disease; Treatment efficiency; Infant; Sequela; Hyaline membrane; Long term; Newborn diseases; Lung function; Pulmonary surfactant; Respiratory distress
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(05)83439-0

The pulmonary outcome for preterm infants 1 years after synthetic surfactant replacement for respiratory distress syndrome was assessed by examining their pulmonary status and the results of pulmonary function tests. A total of 47 infants were followed: 13 infants mean±SD: birth weight, 1960±616 gm; gestation, 32±1.1 weeks) had been assigned to the placebo group and 34 (birth weight=1890±530 gm; gestation=32±2.5 weeks) to surfactant treatment. The infants were examined at 3 to 6 months of age (n=45) and at 9 to 12 months of age (n=36). There were no significant differences between the two groups in predisposing clinical conditions that would lead to chronic lung disease. The infants had similar patterns of growth, respiratory-related illness, and need for theophylline therapy, diuretic therapy, or both. None had hypoxemia by pulse oximetry. Mean (±SEM) values for pulmonary mechanics and energetics in surfactant-treated infants were significantly ( p<0.01) lower for total pulmonary resistance in late infancy (57.7±11.7 vs 35.3±4.6 cm H 2O/L per second). Lower values (mean±SEM) of resistive work of breathing were also measured in the surfactant-treated group (60.7±12.0 vs 38.2±3.6 gm-cm/kg per breath). The dynamic pulmonary compliance values were in the low-normal range for both groups, and the mean (±SEM) peak-to-peak esophageal pressure values were elevated (11.47±2.26 cm H 2O in the placebo group; 9.24±0.69 cm H 2O in the surfactant group). Forced expiratory flow measurements in late infancy demonstrated significant ( p<0.01) improvement in expiratory reserves and reduced evidence of airflow obstruction in the surfactant-treated infants (peak flow (mean±SEM): 287.1±69 vs 396.9±27 ml/sec; forced expiratory flow (mean±SEM) at functional residual capacity: 56.3±7.5 vs 83.4±19.5 ml/sec). No significant differences in pulmonary functions were noted in early infancy. These data suggest that surfactant replacement for respiratory distress syndrome may be associated with beneficial long-term effects on the resistive airflow properties of larger preterm infants.