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Surfactant Treatment of Full-Term Newborns With Respiratory Failure
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1991
Year
Acute Lung InjuryAsthmaSurfactant TreatmentNeonatologyPulmonary SurfactantSurfactant InactivationInhalation ToxicologyPediatricsPediatric Lung DiseaseNewborn MedicinePulmonary MedicineToxicologyRespiratory Distress Syndrome (Neonatal Medicine)Respiration (Physiology)MedicineLung InjuryAnesthesiologyNeonatal Pulmonary Physiology
Surfactant inactivation is a key factor in animal lung injury models and may contribute to respiratory failure in full‑term newborns. Fourteen full‑term infants with pneumonia or meconium aspiration received 90 mg/kg calf lung surfactant intratracheally, up to four doses every six hours, with baseline FiO₂ of 0.99 and MAP of 14.6 cm H₂O. Oxygenation improved markedly after surfactant: the arterial‑alveolar ratio rose from 0.09 to 0.22 within 15 minutes and remained elevated for six hours, the oxygenation index fell from 26.2 to 11.2 at 15 minutes and stayed low for over six hours, and chest radiographs showed a modest improvement from 2.9 to 2.5. Abstract truncated at 250 words.
Surfactant inactivation has been shown to be a significant factor in animal models of lung injury and may also be important in some forms of respiratory failure in full-term newborns. Fourteen full-term newborns with respiratory failure associated with pneumonia (7 patients) and meconium aspiration syndrome (7 patients) were treated with 90 mg/kg of a calf lung surfactant extract, given intratracheally up to every 6 hours for a maximum of four doses. The group mean fraction of inspired oxygen (FI02) before treatment was 0.99 +/- 0.01 SEM, and the mean airway pressure (MAP) was 14.6 +/- 1.0 cm H2O. Patients showed significant improvement in oxygenation after initial surfactant treatment, with the arterial-alveolar oxygenation ratio (a/A ratio) rising from 0.09 +/- 0.01 before surfactant treatment to 0.22 +/- 0.05 by 15 minutes (P = .03) and remaining improved for 6 hours. The oxygenation index, incorporating MAP as well as oxygen variables, also improved significantly from 26.2 +/- 3.1 to 11.2 +/- 1.7 at 15 minutes (P less than .001), with improvement sustained for more than 6 hours. Chest radiographs were blindly scored from 0 (normal) to 5 (severe opacification), and these improved with marginal significance after initial surfactant treatment (from 2.9 +/- 0.2 to 2.5 +/- 0.2, P = .05). (ABSTRACT TRUNCATED AT 250 WORDS)