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Modifications of surfactant phospholipid pattern in premature infants treated with curosurf: clinical and dietary
Insights
Neonatal respiratory distress syndrome (RDS) treatment with surfactant replacement therapy showed evolving surfactant phospholipids. Exogenous phospholipids during total parenteral nutrition did not alter plasma phospholipid subcomponents.
Area of Science:
- Neonatology
- Biochemistry
- Pediatric Pulmonology
Background:
- Neonatal respiratory distress syndrome (RDS) is linked to immature surfactant phospholipid profiles.
- Surfactant replacement therapy is a cornerstone in managing RDS.
Purpose of the Study:
- To examine surfactant phospholipid changes over six days in premature infants with RDS, both before and after Curosurf treatment.
- To investigate potential interactions between exogenous phospholipids in total parenteral nutrition (TPN) and surfactant composition.
Main Methods:
- Seventeen premature infants with RDS were enrolled and randomized into two groups: TPN with lipids or TPN with glucose.
- Surfactant phospholipids were analyzed over a 6-day period.
- Plasma phospholipid subcomponents, cholesterol, and cholesteryl esters were measured.
Main Results:
- Both groups exhibited similar surfactant phospholipid evolution, shifting towards a mature pattern by day 6, with low phosphatidylglycerol compensated by increased phosphatidylinositol and phosphatidylserine.
- Plasma phospholipid subcomponents remained stable across both groups.
- The lipid group had higher total calorie intake, while the glucose group showed elevated plasma total cholesterol and cholesteryl esters.
Conclusions:
- Surfactant replacement therapy promotes a shift towards a mature surfactant phospholipid profile in premature infants with RDS.
- Exogenous phospholipids administered via TPN do not significantly alter plasma phospholipid profiles or surfactant composition in the short term.
- Further research may be needed to understand the long-term effects and optimal lipid formulations in TPN for neonates with RDS.
Abstract:
Neonatal respiratory distress syndrome (RDS) is characterized by an immature surfactant phospholipid pattern. We aimed to study the evolution of surfactant phospholipids over a 6-day period, before and after surfactant replacement therapy with Curosurf, and to investigate possible interactions with exogenous phospholipids administered during total parenteral nutrition (TPN). Seventeen premature infants with RDS were randomly assigned to receive TPN with lipids or without (glucose group). Both groups showed a similar evolution of the surfactant phospholipids. At day 6, the surfactant composition had changed towards a mature human surfactant pattern except for phosphatidylglycerol which remained low (1%), compensated for by a high phosphatidylinositol and phosphatidylserine proportion (13.3%), Phospholipid subcomponents in plasma remained unchanged in both groups. Plasma total cholesterol (151 +/- 18 vs. 113 +/- 6 mg/dl, p less than 0.05) and cholesteryl esters (172 +/- 20 vs. 113 +/- 9 mg/dl, p less than 0.01) were higher in the glucose than in the lipid group. Total calorie intake was significantly higher in the lipid group (85 +/- 4 vs. 64 +/- 6 kcal/kg.day, p less than 0.01).