Treatment of patent ductus arteriosus after exogenous surfactant in baboons with hyaline membrane disease

• Published in: Pediatric research Vol. 26; no. 6; pp. 565 - 569
• Main Authors: SHIMADA, S, RAJU, T. N. K, RAMA BHAT, MAETA, H, DHARMAPURI VIDYASAGAR
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.12.1989
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Animals, Newborn; Biological and medical sciences; Blood Pressure; Ductus Arteriosus, Patent - complications; Ductus Arteriosus, Patent - physiopathology; Ductus Arteriosus, Patent - therapy; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Female; Humans; Hyaline Membrane Disease - complications; Hyaline Membrane Disease - drug therapy; Hyaline Membrane Disease - physiopathology; Infant, Newborn; Intensive care medicine; Lung - physiopathology; Male; Medical sciences; Oxygen - blood; Papio; Pulmonary Circulation; Pulmonary Surfactants - adverse effects; Pulmonary Surfactants - therapeutic use; Premature; Exogenous; Prognosis; Congenital; Respiratory disease; Idiopathic; Monkey; Ductus arteriosus; Vertebrata; Mammalia; Pulmonary surfactant; Animal; Heart disease; Surgery; Primates; Respiratory distress; Resuscitation
• ISSN: 0031-3998; 1530-0447
• DOI: 10.1203/00006450-198912000-00010

The effect of early treatment of patent ductus arteriosus (PDA) on the acute course of hyaline membrane disease was tested in a primate model, after intratracheal administration of 100 mg/kg exogenous bovine surfactant phospholipids at mean ages between 2.3-2.4 h. Twenty-two premature baboons were divided into four groups: seven animals were controls (group A); five were treated with surfactant but PDA was not intervened (group B); in five surfactant treatment was followed by three doses of 0.2 mg/kg intravenous indomethacin beginning at a mean age of 5.5 h (group C); and in five surfactant treatment was followed by a surgical ligation of PDA between 5-5.5 h of age. After surfactant instillation in groups B, C, and D, a prompt and sustained improvement was noted in a/APO2, mean airway pressure, ventilator efficiency index and pulmonary compliance. However, no consistent differences were found in the respiratory variables within the surfactant treated groups during the 72-h experiment: the respiratory course in the animals treated for PDA (groups C and D) was generally similar to the animals in which PDA was not treated (group B). In animals treated with surfactant and indomethacin (group C) the mean aortic blood pressure was maintained more optimally as compared to the other three groups. These findings suggest that although a significant early ductal shunting does occur after exogenous surfactant therapy in this animal model, the expected pulmonary deterioration does not occur, and an early abrupt interruption of PDA does not seem to provide additional advantage to the immediate course of hyaline membrane disease.