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Objective-To determine prospectively the eYcacy of surfactant in acute respiratory distress syndrome. Study design-Twenty patients, 1 month to 16 years of age, diagnosed with an acute pulmonary disease with severe hypoxaemia (PaO 2 /FiO 2 < 100) (13 with systemic or pulmonary disease and seven with cardiac disease) were treated with one to six doses of 50-200 mg/kg of porcine surfactant administered directly into the trachea. The surfactant was considered to be eVective when the PaO 2 /FiO 2 improved by > 20%. Results-After initial surfactant administration the PaO 2 /FiO 2 increased significantly in patients with systemic or pulmonary disease from 68 to 111, and the oxygenation index (OI) diminished significantly from 36.9 to 27.1. The PaO 2 /FiO 2 and OI did not improve in children with cardiac disease. The improvement of the patients who survived was greater than that of those who died. Conclusions-Surfactant moderately improves oxygenation in some children with severe acute respiratory distress syndrome secondary to pulmonary or systemic disease. (Arch Dis Child 1999;80:248-252) Keywords: surfactant; acute respiratory distress syndrome; lung disease Acute respiratory distress syndrome (ARDS) in children can be secondary to multiple causes acting by diVerent mechanisms, such as: direct endothelial damage, decrease and alteration of surfactant, cellular damage by mediators of inflammation (cytokines, complement, products of coagulation, metabolites of arachidonic acid, proteases, and free radicals), and the activation of platelets and leucocytes. These causes produce an alteration in the alveolar capillary membrane, which results in increased permeability and secondary pulmonary oedema.

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Among infants ≤ 90 days of age with fever without source, E. coli was the most common pathogen isolated from urine, blood, and cerebrospinal fluid cultures.

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