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Prophylactic treatment of premature babies with artificial surfactant (ALEC)
1Department of Paediatrics, University of Cambridge, UK.
Insights
Artificial surfactant (ALEC) significantly reduces mortality in premature infants. This innovative treatment, administered at birth, also lowers the incidence of serious complications like respiratory distress syndrome and brain hemorrhages.
Area of Science:
- Neonatal Medicine
- Pulmonology
- Biomaterials
Background:
- Respiratory Distress Syndrome (RDS) is a major cause of mortality in preterm infants.
- Artificial lung surfactants aim to improve respiratory outcomes in neonates.
Purpose of the Study:
- To evaluate the efficacy and safety of an artificial surfactant (ALEC) in preterm infants.
- To assess ALEC's impact on neonatal mortality and major complications.
Main Methods:
- Three clinical trials involving infants under 30 weeks gestation.
- ALEC administered at birth via pharyngeal or endotracheal routes.
- Comparison with control groups receiving placebo (saline or no treatment).
Main Results:
- Significant reduction in neonatal mortality across trials (e.g., 41% to 7%, 31% to 9%, 27% to 14%).
- Decreased incidence of respiratory distress syndrome (RDS) and periventricular/intracerebral hemorrhages.
- Reduced need for mechanical ventilation and supplemental oxygen.
Conclusions:
- Artificial surfactant (ALEC) is effective in reducing mortality and major morbidities in preterm infants.
- ALEC represents a promising therapeutic option for managing RDS in neonates.
- Further research may explore optimal dosing and administration strategies for ALEC.
Abstract:
Artificial surfactant (ALEC) made from DPPC and uPG 7:3 w/w has been given at birth to babies under 30 weeks of gestation in three trials. The first trial enrolled 62 resuscitated babies: 28 treated with 25 mg ALEC powder and 34 controls. The mortality fell from 41 to 7% (p = 0.0005). In the second trial babies were randomized to receive 1 ml of 100 mg ALEC suspension into the pharynx at birth and up to 3 more endotracheal doses in 24 h. Controls received 1 ml of saline. There were 69 ALEC-treated babies and 67 controls. The mortality due to complications of respiratory distress syndrome (RDS) fell from 31 to 9% (p less than 0.01); periventricular haemorrhage was reduced from 40 to 19% (p less than 0.01). The third trial involved 328 babies randomized in 10 centres. ALEC treatment reduced the neonatal mortality from 27 to 14% (p less than 0.002); intracerebral haemorrhages fell from 24 to 16% (p = 0.06) and severe RDS by 27% (p less than 0.03). Regression analysis showed a significant reduction in hours receiving ventilation and greater than 30% oxygen during the first 10 days.