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Surfactant substitution in ventilated very low birth weight infants: factors related to response types
H Segerer1, P Stevens, B Schadow
1Department of Neonatology, Children's Hospital, Universitätsklinikum Rudolf Virchow, Berlin, Germany.
Insights
Surfactant substitution benefits very low birth weight infants with respiratory distress syndrome, even those with other pulmonary issues. Rapid and sustained response indicates a better prognosis, highlighting its prognostic value.
Area of Science:
- Neonatology
- Pulmonology
- Biochemistry
Background:
- Respiratory distress syndrome (RDS) is a common condition in very low birth weight infants.
- Surfactant deficiency is a primary cause of RDS, but other pulmonary disorders also affect these infants.
- Understanding factors influencing surfactant therapy response is crucial for optimizing treatment and outcomes.
Purpose of the Study:
- To investigate factors influencing the therapeutic response to surfactant substitution in very low birth weight infants with RDS.
- To categorize the response to surfactant therapy (Curosurf) based on oxygenation changes.
- To evaluate the prognostic value of different response types.
Main Methods:
- Thirty-five very low birth weight infants with RDS received Curosurf between 3-12 hours of age.
- Therapeutic response was classified as rapid and sustained, rapid with relapse, or poor based on oxygenation.
- Gastric aspirate samples were analyzed for phospholipids and surfactant protein A to assess lung maturity.
Main Results:
- Infants with accelerated lung maturity (n=16) often responded well to surfactant, even with complicating factors like birth asphyxia or infection.
- Infants with immature lung profiles (n=19) predominantly showed a rapid initial response.
- Higher fraction of inspired oxygen before treatment was associated with a poor response; prognosis was linked to response type, with sustained responders having better survival rates (p < 0.05).
Conclusions:
- Surfactant substitution is beneficial for very low birth weight infants with RDS, including those with other pulmonary disorders.
- Factors like lung maturity and pre-treatment oxygen requirements influence response.
- The type of therapeutic response to surfactant substitution has significant prognostic value for survival.
Abstract:
We investigated factors than may influence the response to surfactant substitution. Thirty-five very low birth weight infants with respiratory distress syndrome were treated with Curosurf at 3-12 h of age. From the changes in oxygenation, the therapeutic response was categorized as rapid and sustained, rapid with relapse, or poor. Phospholipids and surfactant protein A were quantified in gastric aspirate samples obtained immediately after birth. They showed that 16 infants had accelerated lung maturity, despite clinical and radiologic signs of respiratory distress syndrome. Ten of them had suffered from birth asphyxia or connatal infection. Nevertheless, 12 of these 16 infants responded rapidly to surfactant substitution. Poor response was seen in four infants with connatal infection. Of 19 infants with immature lung profile, 18 showed a rapid initial response to surfactant substitution. Dynamic compliance of the respiratory system or arterial blood pressure before substitution, the ultrastructure of the surfactant preparation, or persistence of the ductus arteriosus did not influence the response type, but fraction of inspired oxygen was higher before surfactant substitution in infants with poor response. Prognosis was related to short-term response: Of 17 infants who showed a rapid and sustained response, none died, whereas eight of 18 infants with relapse after rapid initial response or poor response died (p less than 0.05). We conclude that surfactant substitution may be beneficial not only in babies with primary surfactant deficiency but also in other pulmonary disorders that are common in very low birth weight infants. The type of response may be of prognostic value.