Pathophysiology of congenital diaphragmatic hernia III: Exogenous surfactant therapy for the high-risk neonate with CDH

Glick, Philip L.; Leach, Corinne L.; Besner, Gail E.; Egan, Edmund A.; Morin, Frederick C.; Malanowska-Kantoch, Anna; Robinson, Luther K.; Brody, Alan S.; Lele, Amol; McDonnell, Margaret; Holm, Bruce A.; Rodgers, Brian T.; Msall, Michael E.; Courey, Norman G.; Karp, Melvyn P.; Allen, James E.; Jewett, Theodore C.; Cooney, Donald R.

doi:10.1016/0022-3468(92)90386-l

Cited by 139 publications

(42 citation statements)

References 27 publications

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“…When the surfactant was given prophylactically to high-risk neonates with CDH, all three infants survived. 95 Surfactant treatment in nine infants with CDH who required ECMO had no beneficial effect on lung function, morbidity or survival. 96 Recent studies on surfactant supplementation in CDH 97 show no benefit associated with surfactant therapy for term infants with a prenatal diagnosis of isolated CDH and a lower survival rate in CDH preterm infants treated with surfactant therapy.…”

Section: Cdhmentioning

confidence: 93%

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Pulmonary surfactant kinetics of the newborn infant: novel insights from studies with stable isotopes

et al. 2009

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Deficiency or dysfunction of the pulmonary surfactant plays a critical role in the pathogenesis of respiratory diseases of the newborn. After a short review of the pulmonary surfactant, including its role in selected neonatal respiratory conditions, we describe a series of studies conducted by applying two recently developed methods to measure surfactant kinetics. In the first set of studies, namely 'endogenous studies', which used stable isotope-labeled intravenous surfactant precursors, we have shown the feasibility of measuring surfactant synthesis and kinetics in infants using several metabolic precursors, including plasma glucose, plasma fatty acids and body water. In the second set of studies, namely 'exogenous studies', which used a stable isotope-labeled phosphatidylcholine (PC) tracer given endotracheally, we estimated the surfactant disaturated phosphatidylcholine (DSPC) pool size and half-life. The major findings of our studies are presented here and can be summarized as follows: (a) the de novo synthesis and turnover rates of the surfactant (DSPC) in preterm infants with respiratory distress syndrome (RDS) are very low with either precursor; (b) in preterm infants with RDS, pool size is very small and half-life much longer than what has been reported in animal studies; (c) patients recovering from RDS who required higher continuous positive airway pressure pressure after extubation or reintubation have a lower level of intrapulmonary surfactant than those who did well after extubation; (d) term newborn infants with pneumonia have greatly accelerated surfactant catabolism; and (e) infants with uncomplicated congenital diaphragmatic hernia (CDH) and on conventional mechanical ventilation have normal surfactant synthesis, but those requiring extracorporeal membrane oxygenated (ECMO) do not. Information obtained from these studies in infants will help to better tailor exogenous surfactant treatment in neonatal lung diseases.

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Section: Cdhmentioning

confidence: 93%

“…There are only a few reports of surfactant treatment in human CDH infants. [94][95][96] Bos et al 94 showed an improvement of oxygenation in three of five infants with CDH after surfactant administration. When the surfactant was given prophylactically to high-risk neonates with CDH, all three infants survived.…”

Section: Cdhmentioning

confidence: 97%

Pulmonary surfactant kinetics of the newborn infant: novel insights from studies with stable isotopes

et al. 2009

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“…7 Surfactant was not used in our patients, as only limited studies have shown that its use contributes to an increase in the survival rate in patients with CDH. 6 ECMO was not used as a mode of treatment for our patients who failed to respond to other modes of treatment because this therapy was not available for small infants in our hospital. Recent studies show improvement in the survival rate with the use of ECMO.…”

Section: Discussionmentioning

confidence: 99%

“…4 Recently, newer modes of therapy have been used, such as extracorporeal membrane oxygenation (ECMO), high-frequency oscillatory ventilation (HFOV), surfactant and inhaled nitric oxide (INO). [5][6][7][8] King Faisal Specialist Hospital and Research Centre (KFSH&RC) is a tertiary care center which provides medical care for a large population referred from different districts of Saudi Arabia. In this study, we present our experience concerning infants with CDH, in an attempt to find prognostic factors that may help in the management of infants with CDH in the future.…”

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confidence: 99%

Congenital Diaphragmatic Hernia: A Local Experience

et al. 1999

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Background:The objective of this study was to review infants with congenital diaphragmatic hernia (CDH) from the clinical and surgical aspects, and to analyze the risk factors affecting the outcome. Patients and Methods: The records of 33 infants with CDH who were admitted to the Neonatal Intensive Care Unit (NICU) from January 1989 to July 1996 were retrospectively reviewed. The mean gestational age was 38.87±2.6 weeks and the mean birth weight was 2896±700 g. The male to female ratio was 2:1. Twenty-six infants had leftsided and seven had right-sided CDH. All infants required mechanical ventilation within six hours of being born. Results: Nineteen infants survived until hospital discharge and 14 infants died, giving an overall mortality rate of 43%. We noted that pH of less than 7.3, PaCO2 of more than 45 mm Hg, or peak inspiratory pressure of more than 25 cm, were associated with high mortality. A higher risk of mortality was also seen in infants with persistent pulmonary hypertension of the newborn (PPHN). Survival rate was observed to be slightly higher in infants who had surgical repair beyond 48 hours of age. Survivors and nonsurvivors were comparable in terms of a 5-minute Apgar score, sex, mode of delivery, PaCO2 at presentation, the site of diaphragmatic defect, air leak syndrome, associated congenital heart disease, and the presence of stomach or viscera in the thorax. Conclusion: High ventilatory support and moderate-to-severe respiratory acidosis at presentation and PPHN during hospital course were found to be associated with high mortality. Ann Saudi Med 1999;19(6):501-504.

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“…Existem evidências da experimentação animal 66 e em humanos 67 que sugerem melhora da função pulmonar e da oxigenação com o uso de surfactante exógeno na hérnia diafragmática congênita, com melhora da sobrevida. No entanto, a falta de estudos randomizados e controlados, de maior casuística, não permite assumir que os efeitos bené-ficos, em curto prazo, se reflitam em melhora da mortalidade ou morbidade em longo prazo.…”

Section: Hérnia Diafragmática Congênitaunclassified

Terapia com surfactante pulmonar exógeno: o que é estabelecido e o que necessitamos determinar

Rebello

Proença

Troster

et al. 2002

J. Pediatr. (Rio J.)

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ResumoObjetivo: revisar os aspectos já consagrados da terapêutica com surfactante exógeno, e discutir o estágio atual da pesquisa onde ainda não existe consenso.Fonte dos dados: revisão bibliográfica, utilizando o banco de dados Medline e Cochrane Database Library, associada à experiên-cia dos autores em relação à terapêutica de reposição do surfactante exógeno.Síntese dos dados: os aspectos principais em relação às características do surfactante: composição, pool, metabolismo, inativação e efeitos imediatos após sua administração já estão bem estabelecidos. Mas ainda permanecem diversas dúvidas em relação ao uso do surfactante exógeno, que ainda é preciso determinar, como a escolha do tipo de surfactante, o momento mais apropriado para o tratamento, a dose e o número de doses, a melhor técnica de administração e as complicações associadas ao seu uso. Atualmente, a pesquisa no campo da terapêutica com surfactante exógeno concentra-se em duas linhas principais: o uso do surfactante em outras patologias que não a síndrome de desconforto respiratório do recém-nascido, e o desenvolvimento de novos surfactantes através da adição de proteínas, ou análogos de proteínas, com o objetivo de melhorar sua ação e de reduzir sua inativação por proteínas plasmá-ticas.Conclusões: hoje, a utilização do surfactante exógeno tornou-se rotina dentro das unidades de terapia intensiva neonatais, mas permanece aberto um campo de pesquisa tanto em nível experimental como clínico.J Pediatr (Rio J) 2002; 78 (Supl.2): S215-S226:surfactante, recém-nascido, síndrome do desconforto respiratório. AbstractObjective: to review well-known aspects of exogenous surfactant therapy, and to discuss controversial points regarding the current state of research.Sources: review of the literature, using Medline and Cochrane Database Library, in association with the authors' experience in relation to exogenous surfactant replacement therapy.Summary of the findings: the main aspects of surfactant characteristics: composition, pool, metabolism, inactivation and immediate effects after its administration are well established. However, there are some doubts related to the use of exogenous surfactants that need to be cleared up: choice of surfactant type, most appropriate length of treatment, adequate dose and number of doses, best administration route and complications associated with its use. Currently, the research about exogenous surfactant therapy focuses on two aspects: the use of surfactant in other pathologies besides the respiratory distress syndrome of the newborn, and the development of new surfactants through the addition of proteins or analogous proteins, with the aim of improving its action and reducing its inactivation.Conclusions: the use of exogenous surfactant has become a routine in neonatal intensive care units, but both clinical and experimental research is still necessary.

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Pathophysiology of congenital diaphragmatic hernia III: Exogenous surfactant therapy for the high-risk neonate with CDH

Cited by 139 publications

References 27 publications

Pulmonary surfactant kinetics of the newborn infant: novel insights from studies with stable isotopes

Pulmonary surfactant kinetics of the newborn infant: novel insights from studies with stable isotopes

Congenital Diaphragmatic Hernia: A Local Experience

Terapia com surfactante pulmonar exógeno: o que é estabelecido e o que necessitamos determinar

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