Published online August 1, 2007
PEDIATRICS Vol. 120 No. 2 August 2007, pp. 346-353 (doi:10.1542/peds.2007-0095)
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ARTICLE

Surfactant Function and Composition in Premature Infants Treated With Inhaled Nitric Oxide

Philip L. Ballard, MD, PhDa, Jeffrey D. Merrill, MDb, William E. Truog, MDc, Rodolfo I. Godinez, MD, PhDd, Marye H. Godinez, MDd, Theresa M. McDevitt, MSb, Yue Ning, MSb, Sergio G. Golombek, MD, MPHe, Lance A. Parton, MDe, Xianqun Luan, MSf, Avital Cnaan, PhDf and Roberta A. Ballard, MDa

a Department of Pediatrics, University of California, San Francisco, California
b Departments of Pediatrics
d Critical Care/Anesthesia
f Biostatistics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
c Department of Pediatrics, Children's Mercy Hospitals and Clinics/University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
e Department of Pediatrics, New York Medical College/Marie Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York

OBJECTIVES. We hypothesized that inhaled nitric oxide treatment of premature infants at risk for bronchopulmonary dysplasia would not adversely affect endogenous surfactant function or composition.

METHODS. As part of the Nitric Oxide Chronic Lung Disease Trial of inhaled nitric oxide, we examined surfactant in a subpopulation of enrolled infants. Tracheal aspirate fluid was collected at specified intervals from 99 infants with birth weights <1250 g who received inhaled nitric oxide (20 ppm, weaned to 2 ppm) or placebo gas for 24 days. Large-aggregate surfactant was analyzed for surface activity with a pulsating bubble surfactometer and for surfactant protein contents with an immunoassay.

RESULTS. At baseline, before administration of study gas, surfactant function and composition were comparable in the 2 groups, and there was a positive correlation between minimum surface tension and severity of lung disease for all infants. Over the first 4 days of treatment, minimum surface tension increased in placebo-treated infants and decreased in inhaled nitric oxide–treated infants. There were no significant differences between groups in recovery of large-aggregate surfactant or contents of surfactant protein A, surfactant protein B, surfactant protein C, or total protein, normalized to phospholipid.

CONCLUSIONS. We conclude that inhaled nitric oxide treatment for premature infants at risk of bronchopulmonary dysplasia does not alter surfactant recovery or protein composition and may improve surfactant function transiently.

Key Words: nitric oxide • premature infant • surface tension • surfactant dysfunction • respiratory severity score

Abbreviations: BPD—bronchopulmonary dysplasia • SP—surfactant protein • iNO—inhaled nitric oxide • NO—nitric oxide • TAF—tracheal aspirate fluid • CLD—chronic lung disease

Accepted Mar 16, 2007.




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W. E. Truog, R. J. Martin, R. A. Ballard, D. Black, A. Cnaan, and For the NO CLD Study Group
Inhaled Nitric Oxide for Preterm Infants
Pediatrics, June 1, 2008; 121(6): 1287 - 1288.
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