Published online October 12, 2009
PEDIATRICS Vol. 124 No. 5 November 2009, pp. e950-e957 (doi:10.1542/peds.2009-0126)

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ARTICLE

Dosing of Porcine Surfactant: Effect on Kinetics and Gas Exchange in Respiratory Distress Syndrome

Paola Elisa Cogo, MD, PhD^a, Maddalena Facco, MD^a, Manuela Simonato, PhD^a, Giovanna Verlato, MD, PhD^a, Clementina Rondina, MD^b, Aldo Baritussio, MD^c, Gianna Maria Toffolo, PhD^d and Virgilio Paolo Carnielli, MD, PhD^b

Departments of ^a Pediatrics
^c Medical and Surgical Sciences
^d Information Engineering, University of Padua, Padua, Italy
^b Neonatal Division, Institute of Maternal-Infantile Sciences, Polytechnic University of Marche and University Hospital of Ancona, Ancona, Italy

OBJECTIVE: The goal was to study exogenous surfactant disaturated phosphatidylcholine (DSPC) kinetics in preterm infants with respiratory distress syndrome (RDS) who were treated with 100 or 200 mg/kg porcine surfactant.

METHODS: Sixty-one preterm infants with RDS undergoing mechanical ventilation received, within 24 hours after birth, 100 mg/kg (N = 40) or 200 mg/kg (N = 21) porcine surfactant mixed with [U-¹³C]dipalmitoylphosphatidylcholine. Clinical and respiratory parameters were recorded, and DSPC half-life and pool size and endogenous DSPC synthesis rate were calculated.

RESULTS: Clinical characteristics and short-term outcomes did not differ between groups. In the 100 mg/kg group, 28 infants (70%) received a second dose after 25 ± 11 hours and 9 (22.5%) a third dose after 41 ± 11 hours; in the 200 mg/kg group, 6 infants (28.6%) received a second dose after 33 ± 8 hours and 1 a third dose. The DSPC half-life was longer in the 200 mg/kg group (first dose: 32 ± 19 vs 15 ± 15 hours [P = .002]; second dose: 43 ± 32 vs 21 ± 13 hours [P = .025]). DSPC synthesis rates and pool sizes before the first and second doses did not differ between the groups. The 200 mg/kg group exhibited a greater reduction in the oxygenation index than did the 100 mg/kg group after the first (P = .009) and second (P = .018) doses.

CONCLUSIONS: Porcine surfactant given to preterm infants with RDS at a dose of 200 mg/kg resulted in a longer DSPC half-life, fewer retreatments, and better oxygenation index values.

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

Abbreviations: DSPC—disaturated phosphatidylcholine • RDS—respiratory distress syndrome • DPPC—dipalmitoylphosphatidylcholine • FIO₂—fraction of inspired oxygen • MAP—mean airway pressure • TTR—tracer/tracee ratio

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Accepted Jun 5, 2009.

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