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Respiratory compliance in premature babies treated with artificial surfactant (ALEC)
1Department of Paediatrics, University of Cambridge.
Insights
Artificial surfactant (ALEC) improved respiratory compliance in premature infants under 29 weeks gestation. However, ALEC decreased compliance in infants over 29 weeks gestation, particularly those not ventilated.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- Premature infants often experience respiratory distress due to immature lungs.
- Artificial surfactant replacement therapy aims to improve lung function in neonates.
- Understanding the specific effects of artificial surfactant on respiratory compliance is crucial for optimizing treatment.
Purpose of the Study:
- To evaluate the impact of artificial surfactant (ALEC) on respiratory compliance in preterm infants.
- To determine if gestational age influences the efficacy of ALEC therapy.
- To assess the timing of ALEC's effects on respiratory mechanics.
Main Methods:
- A randomized trial involving 294 infants with less than 34 weeks gestation.
- Administration of artificial surfactant (ALEC) at birth.
- Measurement of respiratory compliance at multiple time points (1, 6, 24, 48, and 168 hours) post-birth.
Main Results:
- ALEC significantly improved respiratory compliance at 6 and 24 hours in infants < 29 weeks gestation.
- No significant improvement in compliance was observed at 1, 48, or 168 hours for infants < 29 weeks.
- Infants > 29 weeks gestation showed lower compliance with ALEC, notably at 1 hour in non-ventilated infants.
Conclusions:
- Artificial surfactant (ALEC) demonstrates a beneficial effect on respiratory compliance in extremely preterm infants (< 29 weeks).
- ALEC may have detrimental effects on respiratory compliance in slightly more mature preterm infants (> 29 weeks), especially if not ventilated.
- Gestational age is a critical factor in determining the response to artificial surfactant therapy.
Abstract:
In a randomised trial of artificial surfactant (ALEC) given at birth to 294 babies less than 34 weeks' gestation, the respiratory compliance was measured at 1, 6, 24, 48, and 168 hours after birth. In babies less than 29 weeks' gestation ALEC significantly improved the mean (SEM) compliance at 6 hours from 0.54 (0.06) to 0.91 (0.13) ml/cm H2O/kg and at 24 hours from 0.57 (0.04) to 0.92 (0.10) ml/cm H2O/kg. The improvements at 1, 48, and 168 hours were not significant. In babies of over 29 weeks' gestation the compliance was lower in the ALEC treated babies. This was significant only at one hour: 0.52 (0.03) compared with 0.71 (0.07) ml/cm H2O/kg and only occurred in babies who were not ventilated.