PEDIATRICS Vol. 123 No. 2 February 2009, pp. e367 (doi:10.1542/peds.2008-3728)
LETTER TO THE EDITOR |
A Question of Volume?: In Reply
Giovanna Verlato, MD, PhDPaola Elisa Cogo, MD, PhD
Department of Pediatrics,
University of Padova,
Padova, Italy
Virgilio Paolo Carnielli, MD, PhD
Division of Pediatrics,
Salesi Children Hospital,
University of Ancona,
Ancona, Italy
The letter of Mr Lutchman from Abbott Laboratories South Africa concisely and effectively summarizes 2 of the major issues raised in the discussion of our article.1 There are indeed several unanswered questions on surfactant replacement therapy. The issues of the different surfactant preparations and of the preparation volume are very interesting ones. Information on surfactant kinetics in humans is scarce, and even less is known on how different exogenous preparations are retained and improve lung function of the preterm infant with respiratory distress syndrome. We speculate that the role of the surfactant proteins, which varies greatly between the available surfactant preparations,2,3 may be proven in future studies to be very important. When addressing the issue of surfactant volume there is even less information, and the issue remains highly speculative. On a purely theoretical ground, the larger the volume, the better the distribution; however, the larger the volume, the higher the risk of "flooding" the lungs with excessive amounts of water. As stated above, this issue will remain highly speculative until well-controlled studies in preterm infants are performed. We are currently investigating in preterm infants some of these issues together with the very important issue of lung water clearance.4,5 We thank Mr Lutchman for his interest in our work and for raising interest on some of the numerous unanswered questions about surfactant replacement therapy.
REFERENCES
1. Verlato G, Cogo PE, Balzani M, et al. Surfactant status in preterm neonates recovering from respiratory distress.
Pediatrics. 2008;122
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–108
2. Notter RH. Surface chemistry of pulmonary surfactant: the role of individual components. In: Robertson B, ed. Pulmonary Surfactant. Amsterdam, Netherlands: Elsevier Science Publishers; 1984:7–65
3. Cogo P, Baritussio A, Rosso F, et al. Surfactant-associated protein B kinetics in vivo in newborn infants by stable isotopes. Pediatr Res. 2005;57 (4):519 –522[CrossRef][Web of Science][Medline]
4. Hooper SB, Kitchen MJ, Wallace MJ, et al. Imaging lung aeration and lung liquid clearance at birth.
FASEB J. 2007;21
(12):3329
–3337
5. Jobe AH, Hillman N, Polglase G, Kramer BW, Kallapur S, Pillow J. Injury and inflammation from resuscitation of the preterm infant. Neonatology. 2008;94 (3):190 –196[CrossRef][Web of Science][Medline]
PEDIATRICS (ISSN 1098-4275). ©2009 by the American Academy of Pediatrics
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