Sequential changes in compliance and resistance after bolus administration or slow infusion of surfactant in preterm infants

Abstract

Very slow infusion of natural surfactant is at least as effective as bolus instillation in terms of improvement in C(stat) and oxygenation after 90 min. However, until 90 min the course of C(stat) and indices of gas exchange seem superior after bolus therapy. Because R(rs) is substantially increased, long expiratory times are required to yield complete exhalation.

Respiratory mechanics in ventilated preterm infants: early determinants and outcome

“…66 With increasing RDS severity Crs decreases. 53,112 Decreased neonatal Crs might therefore point to a higher degree of pulmonary immaturity with an increased risk to develop BHR in subsequent years. During the infantile period, bronchial responsiveness decreases with age.…”

Surfactant Replacement Therapy for Respiratory Distress Syndrome in the Newborn: A Review

“…24 These studies compared infants treated with a single dose with either retreatment with up to three doses within the first 72 h for infants who had a deterioration (shown by a 0.1 increase in the fraction of inspired oxygen [FiO2] after an initial response) or retreatment with up to three doses at 12 h and 24 h after the initial dose for infants who remained intubated and required oxygen. 25 It should be noted that the babies studied were a heterogeneous group with gestational ages that ranged from 30 to 36 weeks in one study and a birthweight range of 700 g to 2000 g in the other. 24 Meta-analysis of the trials showed a reduction in the risk of pneumothorax (RR=0.51, 95% CI 0.30 to 0.88; ARD=-0.09, 95% CI -0.15 to -0.02) and a trend toward a reduction in mortality (RR=0.63, 95% CI 0.39 to 1.02; ARD=-0.07, 95% CI -0.14 to 0.0).…”

“…25 Thus, it appears that improvements in outcomes are seen up to a dose of about 120 mg phospholipids/kg body weight for the first dose, larger initial doses do not lead to further improvements in outcomes. 25 Should multiple or single doses of surfactant be used? Two trials of multiple versus single doses of surfactant replacement therapy (which included 394 babies in total) have been reviewed.…”

“…24 Curosurf (Chiesi Pharmaceuticals, Italy) (a natural porcine surfactant) was more effective acutely at 200 mg/kg than 100 mg/kg. 25 It may well be that lower doses would be appropriate for prophylaxis while higher doses might be required for treatment of established RDS when antisurfactant proteins are present in the airspaces. 25 Thus, it appears that improvements in outcomes are seen up to a dose of about 120 mg phospholipids/kg body weight for the first dose, larger initial doses do not lead to further improvements in outcomes.…”

“…In two small randomized trials, such an approach led to a decrease in the need for more than 1 h of mechanical ventilation. 25 If we can give surfactant therapy, do we still need to use antenatal steroids?…”