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June 1993, Vol 147, No. 6 >
Article | June 1993

Surfactant Therapy Failure Identifies Infants at Risk for Pulmonary Mortality FREE

Aaron Hamvas, MD; Thomas Devine; F. Sessions Cole, MD
[+] Author Affiliations

Accepted for publication January 12, 1993.

Reprint requests to Division of Newborn Medicine, St Louis Children's Hospital, 400 S Kingshighway, St Louis, MO 63110 (Dr Hamvas).


Am J Dis Child. 1993;147(6):665-668. doi:10.1001/archpedi.1993.02160300071026.
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References
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• Objective.  —To characterize the clinical features of infants who do not respond to surfactant therapy.

Design.  —Patient series, chart review.

Setting.  —Academic referral neonatal intensive care unit.

Patients/Selection.  —Ninety-nine consecutive infants with respiratory distress syndrome who received surfactant therapy and 107 infants from the 2 years prior to initiation of surfactant therapy matched for birth weight, race, sex, gestational age, chronological age, and disease severity.

Measurements/Results.  —Oxygen index was used to quantitate response to surfactant therapy. A 25% decrease in oxygen index 6 hours after the first surfactant dose was significantly different from that of the matched historical cohort (P=.04). Oxygen index decreased 25% or more in 49 infants, the response group, while oxygen index decreased less than 25% or increased following therapy in the remaining 50 infants, the nonresponse group. Pulmonary interstitial emphysema occurred more frequently in the nonresponse group. The only deaths from pulmonary causes at 10 days of age or younger occurred in the nonresponse group (n=11).

Conclusions.  —Pulmonary processes unresponsive to surfactant therapy contribute to morbidity and mortality in newborn respiratory distress syndrome. Classifying respiratory distress syndrome as "surfactant responsive" or "surfactant unresponsive" offers a scheme by which to investigate alternative explanations and interventions for newborn respiratory distress syndrome.(AJDC. 1993;147:665-668)

REFERENCES

1 +
Kendig JW, Notter RH, Cox C, et al.  A comparison of surfactant as immediate prophylaxis and as rescue therapy in newborns of less than 30 weeks' gestation . N Engl J Med . 1991;;324:865-81.
2 +
Long W, Corbet A, Cotton R, et al.  A controlled trial of synthetic surfactant in infants weighing 1250 g or more with respiratory distress syndrome . N Engl J Med . 1991;;325:1696-1703.
3 +
Long W, Thompson T, Sundell H, et al.  Effects of two rescue doses of a synthetic surfactant on mortality rate and survival without bronchopulmonary dysplasia in 700- to 1350-gram infants with respiratory distress syndrome . J Pediatr . 1991;;118:595-605.
4 +
Phibbs RH, Ballard RA, Clements JA, et al.  Initial clinical trial of EXOSURF, a protein-free synthetic surfactant, for the prophylaxis and early treatment of hyaline membrane disease . Pediatrics . 1991;;88:1-9.
5 +
Charon A, Taeusch HW, Fitzgibbon C, et al.  Factors associated with surfactant treatment response in infants with severe respiratory distress syndrome . Pediatrics . 1989;;83:348-354.
6 +
Collaborative European Multicentre Study Group.  Factors influencing the clinical response to surfactant replacement therapy in babies with severe respiratory distress syndrome . Eur J Pediatr . 1991;;150:433-439.
7 +
Segerer H, Stevens P, Schadow B, et al.  Surfactant substitution in ventilated very low birth weight infants: factors related to response types . Pediatr Res . 1991;;30:591-596.
8 +
Keszler M, Ryckman FC, McDonald J, et al.  A prospective, multicenter, randomized study of high versus low positive end-expiratory pressure during extracorporeal membrane oxygenation . J Pediatr . 1992;;120:107-113.
9 +
Dunn MS, Shennan AT, Possmayer F.  Single- versus multiple-dose surfactant replacement therapy in neonates of 30 to 36 weeks' gestation with respiratory distress syndrome . Pediatrics . 1990;;86:564-571.
10 +
Notter RH, Egan EA, Kwong MS, et al.  Lung suractant replacement in premature lambs with extracted lipids from bovine lung lavage: effects of dose, dispersion technique and gestational age . Pediatr Res . 1985;;19:569-577.
11 +
Farrell EE, Silver RK, Kimberlin LV, et al.  Impact of antenatal dexamethasone administration on respiratory distress syndrome in surfactant-treated infants . Am J Obstet Gynecol . 1989;;161:628-633.
12 +
Blackwell M, Noguchi A, Devaskar U.  Factors associated with non-response to surfactant TA in human neonates . Pediatr Res . 1992;;31: 301A. Abstract.
13 +
Cockshutt AM, Weitz J, Possmayer F.  Pulmonary surfactant-associated protein A enhances the surface activity of lipid extract surfactant and reverses inhibition by blood proteins in vitro . Biochemistry . 1990;;29:8424-8429.
14 +
Kobayashi T, Nitta K, Ganzuka M, et al.  Inactivation of exogenous surfactant by pulmonary edema fluid . Pediatr Res . 1991;;29:353-356.
15 +
Miles PR, Ma JY, Bowman L.  Degradation of pulmonary surfactant desaturated phosphatidyl choline by alveolar macrophages . J Appl Physiol . 1988;;64:2474-2481.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Kendig JW, Notter RH, Cox C, et al.  A comparison of surfactant as immediate prophylaxis and as rescue therapy in newborns of less than 30 weeks' gestation . N Engl J Med . 1991;;324:865-81.
2 +
Long W, Corbet A, Cotton R, et al.  A controlled trial of synthetic surfactant in infants weighing 1250 g or more with respiratory distress syndrome . N Engl J Med . 1991;;325:1696-1703.
3 +
Long W, Thompson T, Sundell H, et al.  Effects of two rescue doses of a synthetic surfactant on mortality rate and survival without bronchopulmonary dysplasia in 700- to 1350-gram infants with respiratory distress syndrome . J Pediatr . 1991;;118:595-605.
4 +
Phibbs RH, Ballard RA, Clements JA, et al.  Initial clinical trial of EXOSURF, a protein-free synthetic surfactant, for the prophylaxis and early treatment of hyaline membrane disease . Pediatrics . 1991;;88:1-9.
5 +
Charon A, Taeusch HW, Fitzgibbon C, et al.  Factors associated with surfactant treatment response in infants with severe respiratory distress syndrome . Pediatrics . 1989;;83:348-354.
6 +
Collaborative European Multicentre Study Group.  Factors influencing the clinical response to surfactant replacement therapy in babies with severe respiratory distress syndrome . Eur J Pediatr . 1991;;150:433-439.
7 +
Segerer H, Stevens P, Schadow B, et al.  Surfactant substitution in ventilated very low birth weight infants: factors related to response types . Pediatr Res . 1991;;30:591-596.
8 +
Keszler M, Ryckman FC, McDonald J, et al.  A prospective, multicenter, randomized study of high versus low positive end-expiratory pressure during extracorporeal membrane oxygenation . J Pediatr . 1992;;120:107-113.
9 +
Dunn MS, Shennan AT, Possmayer F.  Single- versus multiple-dose surfactant replacement therapy in neonates of 30 to 36 weeks' gestation with respiratory distress syndrome . Pediatrics . 1990;;86:564-571.
10 +
Notter RH, Egan EA, Kwong MS, et al.  Lung suractant replacement in premature lambs with extracted lipids from bovine lung lavage: effects of dose, dispersion technique and gestational age . Pediatr Res . 1985;;19:569-577.
11 +
Farrell EE, Silver RK, Kimberlin LV, et al.  Impact of antenatal dexamethasone administration on respiratory distress syndrome in surfactant-treated infants . Am J Obstet Gynecol . 1989;;161:628-633.
12 +
Blackwell M, Noguchi A, Devaskar U.  Factors associated with non-response to surfactant TA in human neonates . Pediatr Res . 1992;;31: 301A. Abstract.
13 +
Cockshutt AM, Weitz J, Possmayer F.  Pulmonary surfactant-associated protein A enhances the surface activity of lipid extract surfactant and reverses inhibition by blood proteins in vitro . Biochemistry . 1990;;29:8424-8429.
14 +
Kobayashi T, Nitta K, Ganzuka M, et al.  Inactivation of exogenous surfactant by pulmonary edema fluid . Pediatr Res . 1991;;29:353-356.
15 +
Miles PR, Ma JY, Bowman L.  Degradation of pulmonary surfactant desaturated phosphatidyl choline by alveolar macrophages . J Appl Physiol . 1988;;64:2474-2481.

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