Surfactant-replacement therapy

Article Abstract:

Treatment of premature infants with surfactant (the substance that normally lines the lungs and lowers the surface tension of the air sacs, preventing lung collapse) has helped reduce mortality due to respiratory distress syndrome, no longer the main cause of death in this population. However, many issues concerning surfactant-replacement treatment have not been resolved. In the US, the only product that is licensed for this use is called Exosurf. Products used in other countries are briefly described. A report in the March 28, 1991 issue of The New England Journal of Medicine compares the effectiveness of surfactant given soon after birth (prophylactically) to all premature infants with that of the drug administered only if the infant later shows signs of respiratory distress. Prophylactic surfactant treatment was more effective, particularly for very premature infants (younger than 26 weeks' gestational age); this may be due, in part, to the fact that they received a higher dose per kilogram body weight. Comparisons between natural (from animal lung extracts) and synthetic surfactants are being carried out. Although prophylactic administration of surfactant was very effective for the most premature infants studied, it results in the treatment of many infants who will never develop respiratory distress syndrome. Moreover, this method requires immediate insertion of a tube into the newborn's airway, preferably before it has drawn its first breath. Since many infants responded very well to treatment following the development of symptoms of respiratory distress, it is not clear that routine prophylactic delivery of surfactant can be recommended. A better approach would be to identify those infants who have surfactant deficiency; ways to test surfactant levels are mentioned briefly. A final problem concerns the lack of response to surfactant replacement by some infants. Additional research concerning surfactant using controlled trials should be carried out. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial, Exosurf Neonatal (Medication)

---

A controlled trial of synthetic surfactants in infants weighing 1250 g or more with respiratory distress syndrome

Article Abstract:

Most of the body's tissues are protected from the harmful drying effects of air by the impermeable covering of skin. However, lung function requires that thin, delicate, moist tissues be in direct contact with air, creating special physiological problems. One problem is that the air-filled alveoli in the lungs will collapse without the proper surface tension of the fluids in contact with the air. The body achieves the proper surface tension within the lung tissues with compounds called surfactants. Natural surfactants, generally obtained from bovine tissue, have been used successfully in the treatment of respiratory distress syndrome (RDS), one of the more serious obstacles to survival facing premature infants. Most of the clinical trials demonstrating the effectiveness of surfactants have examined the treatment of smaller premature infants. Since about half the cases of RDS actually occur in larger infants, it is important to determine if the bovine surfactants prove useful in this group as well. Furthermore, in larger premature infants, the rest of the body is likely to be well developed, and thus the effects of the surfactant on the immature lungs may be observed more clearly. A total of 1,237 premature infants each weighing more than 1,250 grams were randomly assigned to receive surfactant or placebo. The overall death rate was 7 percent among the infants treated with placebo and 4 percent among the infants receiving surfactant. The death rate specifically due to RDS was 3 and 1 percent for the placebo and surfactant-treated groups, respectively. The surfactant-treated group also experienced a lower rate of bronchopulmonary dysplasia and other complications. These results demonstrate that treatment with surfactant can be life-saving when given to larger premature babies and also contributes to an overall decrease in the incidence of serious illness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Birth weight, Low, Low birth weight, Surface active agents

---

Partial liquid ventilation - the future is now

Article Abstract:

Partial liquid ventilation with perflubron could improve survival rates in adults and children with respiratory distress syndrome. Perflubron is an inert substance belonging to a class of chemicals called perfluorocarbons. Perflubron can hold more oxygen than human blood and can open lung passages to facilitate the exchange of oxygen and carbon dioxide. It has been successfully used on adults and a 1996 study found it to be very effective in premature infants. However, it is not known whether it will leave enough natural surfactant so that the infants can be weaned from the ventilator.

Editorial, Methods, Artificial respiration, Mechanical ventilation, Acute respiratory distress syndrome, Adult respiratory distress syndrome, Perfluorocarbons

Similar abstracts:

• Abstracts: Marfan syndrome. Replacement of the aortic root in patients with Marfan's syndrome. Location on chromosome 15 of the gene defect causing Marfan syndrome
• Abstracts: A randomized controlled trial of a reduced daily dose of zidovudine in patients with the acquired immunodeficiency syndrome
• Abstracts: Quality of life in a placebo-controlled trial of zidovudine in patients with AIDS and AIDS-related complex
• Abstracts: Lovastatin-induced lupus erythematosus Efficacy and tolerability of lovastatin in 3390 women with moderate hypercholesterolemia
• Abstracts: Mortality and duration of hemodialysis treatment. Effect of dialyzer reuse on survival of patients treated with hemodialysis

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.