Search

Newborn infants with early signs of chronic lung disease may improve when given a dose of natural lung surfactant taken from cows. Chronic lung disease is a problem for low birth weight infants, and may persist even though respiratory distress syndrome (RDS) has been treated. Replacing lung surfactant may help to reduce an infant's need for oxygen by preventing protein from leaking into airways leading to decreased production of surfactant. Researchers studied 10 preterm newborns less than a month old and weighing less than 1500 grams at birth. Nine of the 10 infants in this study had been previously diagnosed with RDS. One dose of cow lung surfactant improved the infants' ability to inspire oxygen and reduced their need for a ventilator., Objective. To study the effect of a single dose of exogenous bovine surfactant on oxygen and ventilatory requirements of neonates with early chronic lung disease. Study design. Prospective pilot study. Setting. Three regional neonatal intensive care units. Methods. Infants 7 to 30 days old with birth weights less than 1500 g were eligible if they required a fraction of inspired oxygen (FI[O.sub.2]) of more than 0.4, had stable ventilatory requirements for 24 hours before study entry, and showed diffuse haziness on chest radiographs. Those with patent ductus arteriosus or active infection or those receiving steroid therapy were excluded. After treatment with the surfactant, differences in FI[O.sub.2] and the ventilator efficiency index were analyzed using the Wilcoxon signed rank test. Results. Ten patients were recruited. Median values (range): birth weight, 693 g (530 to 1100 g); gestation, 25 weeks (24 to 27 weeks); and postnatal age at study entry, 13 days (9 to 30 days). The FI[O.sub.2] decreased significantly between 0 and 1 hour after surfactant administration, from a median (range) of 0.67 (0.47 to 0.88) to 0.39 (0.28 to 0.63). This effect was sustained for 24 hours (median FI[O.sub.2], 0.36). Although the FI[O.sub.2] subsequently increased to 0.49 (range, 0.35 to 0.88) at 72 hours, it was significantly lower than that entry before the study. There was a trend toward an increase in the ventilator efficiency index at 24 and 48 hours. Conclusions. A single dose of surfactant is effective in reducing oxygen requirements in neonates with early chronic lung disease. Surfactant replacement may be useful adjunctive therapy in these neonates. Pediatrics 1995; 95:851--854; pulmonary surfactant, chronic lung disease of prematurity, bronchopulmonary dysplasia, neonates., ABBREVIATIONS. RDS, respiratory distress syndrome; CLD, chronic lung disease; FI[O.sub.2], fraction of inspired oxygen; VEI, ventilator efficiency index; bLES, bovine lipid extract surfactant. Despite the success of surfactant therapy for [...]

Surfactant therapy appears to be effective treatment for pulmonary hemorrhage in newborns. Surfactants reduce the tension of fluids in the lungs and permit an easier exchange of gases. Surfactants also contribute to the elasticity of lung tissue. The records of 15 newborns who received surfactant therapy for pulmonary hemorrhage were reviewed. Nine of the infants had low birthweights and four of these were classified as small for gestational age. The median age at pulmonary hemorrhage was 24.4 hours. Surfactant therapy began at a median of 10 hours after pulmonary hemorrhage. All infants improved after therapy. The oxygenation index improved in all children from an average of 24.6 before surfactant therapy to an average of 8.6 between three and six hours after therapy. There was no recurrence of pulmonary hemorrhage., Objective. To study the effect of exogenous bovine surfactant on oxygen and ventilatory requirements in neonates with respiratory deterioration due to pulmonary hemorrhage. Design. Retrospective case series. Setting. Three regional neonatal intensive care units. Methods. Infants who received surfactant following a clinically significant pulmonary hemorrhage during the time period July 1991 to December 1993 were identified from a database. Infants were excluded if any other cause was found to explain their deterioration. The primary outcome was change in respiratory status following surfactant therapy, as reflected by oxygenation index (01) and arterial/alveolar oxygen ratio. Data points were taken as averages of 3 through 6 hours and 0 through 3 hours for the 6 hours before and after surfactant. Differences were analyzed using analysis of variance for repeated measures, with treatment and time as co-variates. Results. Fifteen patients fulfilled inclusion criteria. Median values (range): birth weight, 960 g (595 to 4045); age at pulmonary hemorrhage, 24.4 hours (0.3 to 62); and interval between pulmonary hemorrhage and surfactant therapy, 10 hours (3.7 to 46.5). Mean OI improved from 24.6, at 0 to 3 hours presurfactant, to 8.6 at 3 to 6 hours postsurfactant (P < .001). No patient deteriorated following surfactant therapy. The primary respiratory diagnosis was respiratory distress syndrome (RDS) in 8, meconium aspiration syndrome in 3, and isolated pulmonary hemorrhage in 4. All those with RDS had also received surfactant before their pulmonary hemorrhage. Conclusions. Exogenous surfactant appears to be useful adjunctive therapy in neonates with a clinically significant pulmonary hemorrhage. Its use for this indication should be further investigated by a randomized controlled trial. Pediatrics 1995;95:32-36; pulmonary surfactant, pulmonary hemorrhage, neonates.