Prevention of neonatal respiratory distress syndrome by tracheal instillation of surfactant: a randomized clinical trial

With a randomized clinical trial, the possibility was assessed that a tracheal instillation of pulmonary surfactant prior to the first breath might prevent the development of some of the signs of neonatal respiratory distress syndrome. Of the 72 infants in the trial, all born at a gestational age of...

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Bibliographic Details
Published in:Pediatrics (Evanston) 1985-08, Vol.76 (2), p.145-153
Main Authors: ENHORNING, G, SHENNAN, A, POSSMAYER, F, DUNN, M, CHEN, C. P, MILLIGAN, J
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Clinical Trials as Topic
Emergency and intensive care: neonates and children. Prematurity. Sudden death
Female
Fetal Organ Maturity - drug effects
Gestational Age
Humans
Infant, Newborn
Intensive care medicine
Medical sciences
Oxygen - blood
Pregnancy
Pulmonary Surfactants - administration & dosage
Respiratory Distress Syndrome, Newborn - blood
Respiratory Distress Syndrome, Newborn - prevention & control
Trachea - drug effects
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Summary:With a randomized clinical trial, the possibility was assessed that a tracheal instillation of pulmonary surfactant prior to the first breath might prevent the development of some of the signs of neonatal respiratory distress syndrome. Of the 72 infants in the trial, all born at a gestational age of less than 30 weeks, 39 received 3 or 4 mL of surfactant, prepared from the lipids extracted from calf lung lavage. The treatment resulted in a significantly improved gas exchange during the first 72 hours of life. On the average, the arterial/alveolar PO2 ratio was 0.15 higher for the treated infants, and only about half as much extra oxygen had to be supplied. The respiratory support (peak inspiratory pressure X frequency) could be lowered significantly. Pulmonary interstitial emphysema occurred in 13 of the 33 control infants, but in only three of the 39 treated infants. Six of the control infants died in the neonatal period, but only one treated infant died. It is concluded that surfactant supplementation prior to the first breath is feasible and is of value as protection against the respiratory distress syndrome and the negative effects of hypoxia and ventilatory support.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.76.2.145