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Serial phospholipid analysis in preterm infants: comparison of Exosurf and Survanta
1Department of Neonatal Medicine, Westmead Hospital, NSW, Australia. janel@westmed.wh.su.edu.au
Insights
Synthetic and natural surfactants showed no significant differences in lung fluid phospholipid composition in premature infants. This suggests that differences in clinical response and long-term outcomes are not explained by phospholipid profiles.
Area of Science:
- Neonatal Medicine
- Biochemistry
- Pulmonology
Background:
- Infants receiving synthetic surfactant may have increased risks of bronchopulmonary dysplasia and retinopathy of prematurity.
- Differences in phospholipid composition of lung fluid could explain varying clinical responses to synthetic versus natural surfactants.
- Respiratory Distress Syndrome (RDS) is a common condition in premature infants.
Purpose of the Study:
- To investigate if differences in lung fluid phospholipid composition explain clinical outcome variations between synthetic (Exosurf) and natural (Survanta) surfactant treatments in premature infants with RDS.
- To compare the phospholipid profiles of lung aspirates from infants treated with Exosurf, Survanta, and healthy controls.
Main Methods:
- Infants <32 weeks gestation with RDS were randomized to receive Exosurf or Survanta.
- Lung aspirates were collected pre-treatment and up to 28 days post-treatment.
- Phospholipids were separated using thin-layer chromatography and quantified.
Main Results:
- Infants with normal lungs had higher phosphatidylcholine pre-treatment compared to those with RDS.
- At 24 hours, normal lungs showed higher phosphatidylinositol than both treatment groups.
- At 48 hours, the Survanta group had higher phosphatidylglycerol than the normal lung group. No other significant differences in phospholipid profiles were observed up to 28 days between Exosurf and Survanta treated infants.
Conclusions:
- The phospholipid composition of lung aspirates did not explain the observed clinical differences or long-term outcomes between synthetic and natural surfactant treatments.
- Further research is needed to understand the mechanisms behind the differential clinical responses to various surfactant preparations.
Abstract:
The initial clinical response to synthetic or natural surfactant is different and long-term complications from meta-analysis suggest that bronchopulmonary dysplasia and retinopathy of prematurity may be increased in infants given synthetic surfactant. It is possible that this is due to differences in the phospholipid composition of lung fluid following administration of these surfactants. Infants less than 32 weeks gestation with respiratory distress syndrome (RDS) were randomly assigned to receive either Exosurf, an artificial surfactant, or Survanta, a natural surfactant. Endotracheal or hypopharyngeal aspirates were obtained from these infants and from control infants who had normal lungs. The aspirates were taken prior to and up to 28 days following surfactant administration. The different phospholipids were separated by thin layer chromatography and expressed as a percent of total phospholipid measured. Infants with normal lungs had a higher proportion of phosphatidylcholine than those with RDS prior to treatment. The infants with normal lungs had a greater proportion of phosphatidylinositol in their lung aspirates than both treatment groups at 24 h. Infants in the Survanta group had a higher proportion of phosphatidylglycerol at 48 h than the group with normal lungs. No other differences were found in phospholipid composition up to 28 days. There were no major differences in the phospholipid profile in infants with RDS treated with either Exosurf or Survanta. In conclusion, neither the clinical differences initially seen between infants treated with either Exosurf or Survanta, nor the long-term outcome could be explained by the phospholipid composition of serial samples of lung aspirates.