Article Text

  1. J. D. Merrill,
  2. P. L. Ballard,
  3. A. M. Hibbs,
  4. R. I. Godinez,
  5. M. H. Godinez,
  6. X. Luan,
  7. R. Ryan,
  8. A. M. Reynolds,
  9. A. Hamvas,
  10. K. Spence,
  11. S. Courtney,
  12. M. Posencheg,
  13. A. Ades,
  14. D. Lisby,
  15. R. A. Ballard
  1. University of Pennsylvania School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA; Schneider Children's Hospital, NY; Washington University, St. Louis, MO; Women & Children's Hospital, Buffalo, NY


Many extremely low gestational age neonates (≤ 28 wk, ELGANS) continue to require intubation and mechanical ventilation beyond the first week of life and many experience episodes of dysfunctional surfactant associated with low surfactant protein B content and clinically significant respiratory decompensations (Pediatr Res 2004;56:918-26). We hypothesized that booster surfactant treatment (booster) given during week 2-3 to these infants is safe and improves pulmonary outcome. Infants were enrolled in one of two booster pilot trials. ELGANS requiring ventilation at 7 to 10 days of life received one to two doses of “prophylactic” surfactant (Infasurf®, 3 mL/kg) 1 week apart. In a separate “Rescue” pilot trial, ventilated ELGANS at 5 to 21 days of life with respiratory decompensation received two doses of Infasurf over 12 to 24 hours. Tracheal aspirate (TA) samples were analyzed for minimum surface tension (STmin) in a pulsating bubble surfactometer and for concentrations of cytokines, growth factors, and chemokines. Clinical data including respiratory severity score (SS = mean airway press × FiO2) were collected. Twenty-six infants have been enrolled in the ongoing pilot trials. Mean GA and BW were 25.5 ± 1.3 week and 718.3 ± 151.8 g, respectively. Surfactant instillation was tolerated by infants in both trials. Changes in SS, as an index of initial clinical response, are shown as the number of infants with lower SS score/number with same SS score/number with higher SS score compared to the pr-treatment value (mean and range SS):


Following treatment, there was an initial decrease in STmin for most infants, indicating improved function. Analysis of concentrations of IL-1α, IL-1β, IL-6, IL-8, TNFα, IL-10, RANTES, MIP-1α, TGF-β1, and VEGF after treatment revealed no significant changes as compared with pretreatment. These preliminary results support the safety of booster surfactant administration in ventilated ELGANS beyond 7 days of age and indicate a favorable initial response in respiratory status. This therapy will be tested for safety and prevention of bronchopulmonary dysplasia in a multicenter, randomized, controlled trial.

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