Published online July 1, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. 102-108 (doi:10.1542/10.1542/peds.2007-1021)

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ARTICLE

Surfactant Status in Preterm Neonates Recovering From Respiratory Distress Syndrome

Giovanna Verlato, MD, PhD^a, Paola Elisa Cogo, MD, PhD^a, Marco Balzani, MD^a, Antonina Gucciardi, PhD^a, Ilaria Burattini, MD^b, Fernando De Benedictis, MD^c, Giovanna Martiri, MD^b and Virgilio Paolo Carnielli, MD, PhD^b,c

^a Department of Pediatrics, University of Padova, Padova, Italy
^b Division of Neonatology, Institute of Maternal-Infantile Sciences, Polytechnic University of Marche, Ancona, Italy
^c Division of Pediatrics, Salesi Children Hospital, University of Ancona, Ancona, Italy

OBJECTIVE. The goal was to establish whether reduced amounts of pulmonary surfactant contribute to postextubation respiratory failure in preterm infants recovering from respiratory distress syndrome.

METHODS. We prospectively recruited preterm infants who needed mechanical ventilation and exogenous surfactant for treatment of moderate/severe respiratory distress syndrome and could not be extubated before day 3 of life. ¹³C-labeled dipalmitoyl-phosphatidylcholine was administered endotracheally as tracer before extubation, for estimation of surfactant disaturated phosphatidylcholine pool size and half-life. Patients were retrospectively divided into 3 groups, that is, extubation failure if, after extubation, they needed reintubation or continuous positive airway pressure treatment of 6 cmH₂O and fraction of inspired oxygen of >0.4, extubation success if they did not meet the failure criteria, and not extubated if they needed ongoing ventilation. Clinical and respiratory parameters were recorded hourly.

RESULTS. Reliable kinetic data could be obtained for 63 of the 88 enrolled neonates. Sixteen, 23, and 24 neonates were categorized in the extubation failure, extubation success, and not extubated groups, respectively. Clinical and demographic characteristics did not differ between the extubation failure and extubation success groups. Disaturated phosphatidylcholine pool size was smaller in the extubation failure group than in the extubation success group (25 ± 12 vs 43 ± 24 mg/kg) and was 37 ± 32 mg/kg in the not extubated group. Disaturated phosphatidylcholine half-life was 19 ± 7, 24 ± 12, and 28 ± 18 hours in the extubation failure, extubation success, and not extubated groups, respectively.

CONCLUSIONS. In a selected population of preterm infants with moderate/severe respiratory distress syndrome who could not be extubated in the first 3 days of life, infants who were reintubated or needed high continuous positive airway pressure settings after extubation had a smaller disaturated phosphatidylcholine pool size than did those who were successfully extubated or needed low continuous positive airway pressure settings.

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Key Words: pulmonary surfactant • isotopes • low birth weight infants • respiratory distress syndrome

Abbreviations: CPAP—continuous positive airway pressure • DPPC—dipalmitoyl-phosphatidylcholine • EF—extubation failure • ES—extubation success • NE—not extubated • GA—gestational age • FIO₂—fraction of inspired oxygen • PS—pool size • RDS—respiratory distress syndrome • DSPC—disaturated phosphatidylcholine • TA—tracheal aspirate • MAP—mean airway pressure

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Accepted Oct 23, 2007.

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