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Pulmonary function at school-age in surfactant-treated preterm infants
M Gappa1, M M Berner, S Hohenschild
1Department of Pediatric Pulmonology and Neonatology, University Children's Hospital at Hannover, Germany. gappa.monika@mh-hannover.de
Insights
Exogenous surfactant therapy for premature infants with respiratory distress syndrome (RDS) showed no significant long-term lung function differences compared to placebo. Further follow-up is needed due to cooperation issues during lung function tests.
Area of Science:
- Pediatrics
- Neonatology
- Pulmonology
Background:
- Respiratory distress syndrome (RDS) is a common condition in premature infants.
- Exogenous surfactant therapy is a standard treatment for RDS.
- Long-term pulmonary sequelae of surfactant treatment in premature infants are not fully understood.
Purpose of the Study:
- To determine long-term pulmonary sequelae of exogenous surfactant therapy in premature infants with RDS.
- To compare lung function between surfactant-treated and placebo groups at early school-age.
Main Methods:
- A follow-up study of 40 children (22 surfactant-treated, 18 placebo) from a randomized trial.
- Lung function tests (LFTs) including functional residual capacity (FRC), airway resistance (R(aw,exp)), and forced expiratory volume in 1 s (FEV1) were performed.
- Bronchial hyperreactivity was assessed using a standardized running test.
Main Results:
- No significant differences in LFT parameters (FRC, R(aw,exp), FEV1) between surfactant and placebo groups.
- Maximal expiratory flow at 25% vital capacity was below predicted range in both groups.
- No significant difference in bronchial hyperreactivity between the groups.
Conclusions:
- Exogenous surfactant therapy for RDS does not appear to cause major long-term pulmonary abnormalities at early school-age.
- Lung function and bronchial reactivity were similar between surfactant-treated and placebo groups.
- Further follow-up is recommended due to limitations in cooperation during LFTs.
Abstract:
A follow-up study was conducted in 40 children who had been enrolled in a prospective randomized study of exogenous surfactant therapy for respiratory distress syndrome (RDS) (n = 22; S) or placebo (n = 18; P) to determine long-term pulmonary sequelae of surfactant treatment in premature infants with RDS. At follow-up, mean (SD) age was 6.63 (0.18) and 6.55 (0.23) years for S and P, respectively. Complete lung function tests (LFT) were attempted in all patients. Satisfactory data were obtained in 17/22 surfactant-treated and in 12/18 control children. There was no significant difference between groups for any of the parameters measured. Mean (SD) functional residual capacity (FRC) was 92% (16%) and 90% (21%) predicted, mean (SD) airway resistance (R(aw,exp)) was 122% (25%) and 127% (61%), and mean (SD) forced expiratory volume in 1 s (FEV1) was 104% (12%) and 99% (17%) predicted for S and P. Only maximal expiratory flow at 25% vital capacity (L/s) was significantly below the predicted range in S and P groups, with 74% (23%) and 77% (28%), respectively. To test bronchial hyperreactivity, a simple standardized running test was performed: 4 children in S and 5 in P showed a significant response as defined by clinical airway obstruction or changes in FEV1 and/or R(aw), with no significant difference between groups. Although we found no major abnormalities in lung function and no difference between S and P at early school-age, lack of cooperation during lung function tests makes further follow-up necessary.