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Back to Pediatrics Articles
Monday, 15th November 2004
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Research shows that even after premature infants produce surfactant,
it often
fails to function and they may develop lung disease.
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Physicians have known for decades that many premature
babies suffer respiratory problems stemming from
insufficiency of a lung substance called surfactant during
their first few weeks of life. The standard treatment has
been to provide replacement surfactant immediately after
birth. A new study has found that even after infants begin
producing their own surfactant, it often fails to function
properly in premature infants who continue to have lung
disease after their first week.
The study also raises the question of whether additional
replacement surfactant treatment may benefit such infants, just as
it does in the week after birth.
Neonatology researchers from The Children's Hospital of
Philadelphia and the University of Pennsylvania published the study
in the October 20 online edition of the journal Pediatric Research.
It was the first study of surfactant dysfunction in infants beyond
the first week of life.
"We studied premature babies who require mechanical ventilation
to breathe after one week of age," said Philip L. Ballard, M.D.,
Ph.D., director of Neonatology Research at The Children's Hospital
of Philadelphia. "We found that three-quarters of these high-risk
infants have episodes of surfactant dysfunction, and these episodes
are associated with worsening of their respiratory status."
Surfactant is a naturally produced mixture of proteins and lipids
(fats) that lowers surface tension within alveoli, the tiny air sacs
within the lungs. By doing so, it prevents the alveoli from
collapsing during exhalation, and eases the work of breathing.
Premature infants have underdeveloped respiratory systems and do not
produce enough of their own surfactant. Therefore, physicians have
found that supplying replacement surfactant may improve infants'
lung function during the earliest period after birth.
Replacement surfactant is discontinued after babies begin to
produce enough surfactant on their own. However, infants with
persistent lung disease may develop a condition called
bronchopulmonary dysplasia (BPD), in which chronic respiratory
distress makes it necessary for infants to breathe through a
mechanical ventilator. BPD can cause long-term disability or death.
In this study, the researchers analyzed samples of fluid from the
windpipes of 68 premature infants who had breathing tubes between
one to 12 weeks after birth. Seventy-five percent of the infants on
at least one occasion had abnormal surfactant function, and
diminished amounts of an important component of surfactant, called
surfactant protein B. In addition, these surfactant abnormalities
were significantly more likely to occur during periods of
respiratory infection and worsened respiratory status.
Babies are defined as premature if they are born before 37 weeks
of gestation. Most premature babies have symptoms of respiratory
distress, with the risk increasing with greater prematurity. The
infants in this study were very premature, having been born at 23 to
30 weeks gestation.
"Premature infants with continuing respiratory failure and
abnormal surfactant may benefit from treatment with replacement
surfactant--or from strategies to increase their own production of
surfactant," said Dr. Ballard, who has been studying infant lung
development for more than 30 years. He and his colleagues are
currently carrying out a pilot trial of surfactant therapy in
preterm infants older than 7 days, and they are planning a clinical
trial to investigate short- and long-term safety and effectiveness
of surfactant treatment in these infants.
Sources
JEFFREY D. MERRILL, ROBERTA A. BALLARD, AVITAL CNAAN, ANNA MARIA HIBBS, RODOLFO I. GODINEZ, MARYE H. GODINEZ, WILLIAM E. TRUOG,
and PHILIP L. BALLARD. Dysfunction of Pulmonary Surfactant in
Chronically Ventilated Premature Infants. Pediatr Res 2004, DOI:
10.1203/01.PDR.0000145565.45490.D9.
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