Early changes in lung function and response to surfactant replacement therapy

Dynamic respiratory system compliance (Cdyn) was measured in 44 preterm babies before, immediately after, and for 96 h following administration of artificial surfactant (Exosurf). There was no significant change in Cdyn for the whole group over the entire study period. Subdivision into three groups on the basis of Cdyn prior to surfactant revealed a significant and sustained deterioration in lung function in those babies with the highest starting compliance and a significant and sustained improvement in those with the lowest compliance. Inspired oxygen and alveolar/arterial oxygen gradient also exhibited significant differences with least improvement in the babies with the best initial lung function and most improvement in the babies with worst initial lung function and most improvement in the babies with worst initial lung function. Despite clear initial differences in clinical status, neither long-term oxygen requirements nor the incidence of chronic lung disease differed significantly between the three groups. We conclude that the response of an individual baby to the administration of surfactant is, in part, determined by the lung function before surfactant is administered. Babies with higher initial lung compliance are more likely to deteriorate after administration and caution should be used before selection of such babies for surfactant treatment.