Exogenous surfactant replacement therapy of hyaline membrane disease in premature infants

Introduction: Hyaline membrane disease (HMD) is an acute lung disease of preterm babies caused by surfactant insufficiency. Decreased surfactant results in insufficient surface tension in the alveolus during expiration leading to alveolar collapse, atelectasis, impaired gas exchange, severe hypoxia and acidosis, leading to respiratory failure. Surfactant replacement therapy (SRT) is now accepted as the standard treatment of preterm babies with HMD. Objective: The objective of this study was to analyze the outcome of surfactant replacement therapy in preterm babies with hyaline membrane disease. Methodology: This is a prospective observational study conducted at 10 bedded neonatal unit of Pediatrics Department, Kathmandu Medical College Teaching Hospital, Sinamangal. Study duration was of one year period (15 May 2017 – 14 May 2018). Preterm babies from 26 wks–35 wks of gestation with Hyaline Membrane Disease were included in this study whereas babies with lethal congenital malformations eg: Meningomyelocele, Anencephaly, Gastrochisis, Diaphragmatic Hernia were excluded. All preterm babies who had clinical and radiological features of HMD were considered for Surfactant Replacement Therapy (SRT). The surfactant (Survanta; Abboti Laboratories, USA; Dose: 4 ml/kg) was administered intra-tracheally according to standard procedures in four divided aliquot applying INSURE (intubation, surfactant administration and extubation to Bubble CPAP) Technique. Ethical clearance was received from Institutional Review Committee (IRC) of Kathmandu Medical College and Statistical analysis was done with SPSS 19 version with frequency and cross tabulation. Results: In this study of 30 preterm babies with HMD received SRT, 47% (14) were male and 53% (16) were female. The mean birth weight of preterm babies with HMD was 1372.17 ± 395 gms and mean gestational age was 30.1±2.6 weeks. Among 30 preterm babies with HMD receiving SRT, 73.3% (22 babies) discharged from the hospital and 6.3% (8 babies) expired. Among eight expired babies, five died due to pulmonary hemorrhage and three died due to septicemia with DIC. Maximum survival was seen in the gestational age of 30-35 wks and birth weight 1200-2100gms. Conclusion: The use of SRT has improved the survival outcome and decreased the associated morbidities in babies with HMD. The maximum impact of survival was seen among the preterm babies of 30- 35 weeks with birth weight of 1200 -2100 grams.

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Surfactant Replacement Therapy in Newborns with Hyaline Membrane Disease

Critical Care Nursing Clinics of North America ◽

10.1016/s0899-5885(18)30642-7 ◽

1992 ◽

Vol 4 (3) ◽

pp. 515-520

Author(s):

Diana W. Grobman ◽

Mary M. Foley

Keyword(s):

Replacement Therapy ◽

Hyaline Membrane Disease ◽

Surfactant Replacement ◽

Surfactant Replacement Therapy ◽

Hyaline Membrane

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Surfactant replacement therapy in utero for prevention of hyaline membrane disease in the preterm baboon

American Journal of Obstetrics and Gynecology ◽

10.1016/0002-9378(93)90010-g ◽

1993 ◽

Vol 169 (4) ◽

pp. 817-824 ◽

Cited By ~ 20

Author(s):

Henry L. Galan ◽

Cheryl Cipriani ◽

Jacqueline J. Coalson ◽

Jolene D. Bean ◽

Gerald Collier ◽

...

Keyword(s):

Replacement Therapy ◽

Hyaline Membrane Disease ◽

In Utero ◽

Surfactant Replacement ◽

Surfactant Replacement Therapy ◽

Hyaline Membrane

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Surfactant Replacement Therapy

Pediatrics in Review ◽

10.1542/pir.12.9.261 ◽

1991 ◽

Vol 12 (9) ◽

pp. 261-267

Author(s):

Roger F. Soll ◽

Jerold F. Lucey

Keyword(s):

Replacement Therapy ◽

Premature Infants ◽

Pulmonary Surfactant ◽

Critical Role ◽

Current Status ◽

Normal Lung ◽

Toxic Substances ◽

Surfactant Replacement ◽

Surfactant Replacement Therapy ◽

Alveolar Surface

Despite medical and technological advances, respiratory distress syndrome (RDS) remains a major cause of morbidity and mortality in premature infants. Thirty years have passed since Avery and Mead demonstrated that infants dying of RDS were deficient in pulmonary surfactant. In those three decades, advances in our understanding of the composition, function, and metabolism of pulmonary surfactant have finally led to clinical trials of surfactant replacement therapy in thousands of premature infants. This article reviews the current status of surfactant replacement therapy. BACKGROUND Pulmonary surfactant is essential for normal lung function. Surfactant forms a film at the alveolar surface, which prevents the lung from collapsing at the end of expiration. Surfactant may have other functions as well, including the prevention of pulmonary edema, the prevention of infection, and the prevention of lung injury from toxic substances, such as oxygen (Table 1) CHEMICAL MAKEUP The chemical makeup of pulmonary surfactant has been well defined (Table 2). Lipids are the major component, comprising up to 80% to 90% of surfactant by weight. The majority of the lipids in pulmonary surfactant are highly polar phospholipids, predominantly phosphatidylcholine. Three proteins associated with surfactant have been these surfactant proteins may play a critical role in surfactant function by improving the adsorption of surfactant at the alveolar surface and by aiding in surfactant re-uptake and metabolism.

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Computational Modeling of Surfactant-Laden Liquid Plug Propagation in Capillary Tubes

ASME 2012 10th International Conference on Nanochannels, Microchannels, and Minichannels ◽

10.1115/icnmm2012-73039 ◽

2012 ◽

Author(s):

Metin Muradoglu ◽

Ufuk Olgac

Keyword(s):

Replacement Therapy ◽

Pulmonary Surfactant ◽

Distress Syndrome ◽

Standard Treatment ◽

Exogenous Surfactant ◽

Liquid Plug ◽

Front Tracking Method ◽

Surfactant Replacement ◽

Surfactant Replacement Therapy ◽

Shed Light

Pulmonary surfactant is of essential importance in reducing the surface tension on the liquid film that coats the inner surface of the airways and thus making the lung more compliant. Surfactant-deficiency may result in respiratory distress syndrome (RDS), which is especially common in prematurely born neonates. Surfactant replacement therapy (SRT) is a standard treatment, in which a liquid plug with exogenous surfactant is instilled in the trachea, which subsequently propagates by inspiration and spreads the exogenous surfactant to the airways. The efficacy of the treatment depends on various parameters such as the size of the liquid plug, inspiration frequency and the physical properties of the exogenous surfactant. Unsteady simulations are performed to study surfactant-laden liquid plug propagation using finite difference/front-tracking method in order to shed light on the surfactant replacement therapy.

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Lung Surfactant in an Era of Replacement Therapy

PEDIATRICS ◽

10.1542/peds.68.6.781 ◽

1981 ◽

Vol 68 (6) ◽

pp. 781-789

Author(s):

Robert H. Notter ◽

Donald L. Shapiro

Keyword(s):

Replacement Therapy ◽

Current Knowledge ◽

Lung Surfactant ◽

Potential Effect ◽

Human Infant ◽

Strong Interactions ◽

Exogenous Surfactant ◽

Surfactant Replacement ◽

Surfactant Replacement Therapy

In this paper current knowledge of the palmonary surfactant system with particular emphasis on aspects that relate to exogenous surfactant replacement therapy for the neonatal respiratory distress syndrome (RDS) is considered. The work provides an overview, but concentrates on several facets of lung surfactant research that help to elucidate and evaluate past and present attempts toward such therapy. Subjects addressed include the functional need for specific lung surfactant components to obtain optimal surface activity and some of the required surface property measurements to characterize such activity. Also discussed is current knowledge of lung surfactant synthesis and secretion and the potential effect of exogenous surfactant on the endogenous pulmonary surfactant sytem. A primary theme throughout is that an analysis of previous clinical trials involving surfactant replacement shows the necessity for strong interactions with related basic science investigations. It is suggested that future human infant surfactant replacement trials proceed deliberately, and include maximal correlations with basic in vitro research on lung surfactant biophysics and biochemistry and with experiments in animal models.

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Double-Blind Clinical Trial of Calf Lung Surfactant Extract for the Prevention of Hyaline Membrane Disease in Extremely Premature Infants

PEDIATRICS ◽

10.1542/peds.76.4.585 ◽

1985 ◽

Vol 76 (4) ◽

pp. 585-592 ◽

Cited By ~ 3

Author(s):

Melinda S. Kwong ◽

Edmund A. Egan ◽

Robert H. Notter ◽

Donald L. Shapiro

Keyword(s):

Premature Infants ◽

Controlled Trial ◽

Lung Surfactant ◽

Hyaline Membrane Disease ◽

Treated Group ◽

Efficiency Index ◽

Lung Lavage ◽

Exogenous Surfactant ◽

Double Blind ◽

Hyaline Membrane

A prospective, double-blind, controlled trial was conducted to determine whether instillation of an exogenous surfactant into the lungs before the first breath could prevent hyaline membrane disease. The surfactant is calf lung lipid extracted from saline lung lavage. Entry was limited to infants who were 24 to 28 weeks' gestation, who were born at Children's Hospital of Buffalo, and whose mothers had not received betamethasone for more than 24 hours before birth. Treated infants received 3 mL (90 mg) of calf lung surfactant extract instilled into their trachea before the first breath; control infants received 3 mL of normal saline. A prospective scoring system and respiratory support variables were used to compare the groups. At 48 hours of age, only two of 14 calf lung surfactant extract-treated infants (14%) had hyaline membrane disease compared with seven of 13 control infants (54%) (P = .033). Inspired oxygen, mean airway pressure, ventilator rate and ventilator efficiency index were also lower in the treated group during the first 48 hours of life (P < .01 to P < .001). Calf lung surfactant extract instillation at birth appears to be an effective material and method of preventing hyaline membrane disease in extremely premature infants.

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Natural and artificial lung surfactant replacement therapy in premature lambs

Journal of Applied Physiology ◽

10.1152/jappl.1983.55.3.875 ◽

1983 ◽

Vol 55 (3) ◽

pp. 875-883 ◽

Cited By ~ 56

Author(s):

E. A. Egan ◽

R. H. Notter ◽

M. S. Kwong ◽

D. L. Shapiro

Keyword(s):

Replacement Therapy ◽

Dynamic Compression ◽

Lung Surfactant ◽

Blood Gases ◽

Lung Compliance ◽

Molar Ratio ◽

Exogenous Surfactant ◽

Surfactant Replacement ◽

Surfactant Replacement Therapy

The effect of tracheal instillation of surface-active mixtures in premature lambs was studied as an animal model of exogenous surfactant replacement therapy for the respiratory distress syndrome (RDS). Specific mixtures studied were 7:3 (molar ratio) dipalmitoyl phosphatidylcholine (DPPC):egg phosphatidylglycerol (PG) and extracted mixed lipids (with 1% protein) from cow lung lavage (CLL). Preventilatory tracheal instillation of greater than 15 mg/kg of CLL in 10 ml 0.15 M NaCl to premature lambs gave improved alveolar-arterial O2 gradient and blood gases and increased lung compliance, compared with control lambs over a 15-h period. Lambs receiving 7:3 DPPC:PG dispersions were not improved over controls with regard to pressure-volume characteristics and were worse than controls in arterial oxygenation. In terms of in vitro surface properties, both extracted natural CLL and 7:3 DPPC:egg PG were able to lower aqueous surface tension to 1 dyn/cm under dynamic compression. However, the dynamic respreading of CLL films on successive surface cycles was superior to that of 7:3 DPPC:PG. Moreover, after dispersal in 0.15 M NaCl by vortexing (5 mg/80 ml), CLL adsorbed to surface pressure (tau values of 45 dyn/cm within 10 min. 7:3 DPPC:PG adsorbed to significantly lower tau values after subphase dispersal by a variety of methods.

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