Document Detail


Postnatal changes in pulmonary mechanics and energetics of infants with respiratory distress syndrome following surfactant treatment.
MedLine Citation:
PMID:  15985755     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Postnatal alterations in pulmonary mechanics, energetics and functional residual capacity (FRC) describe the structural maturation of the preterm respiratory system. OBJECTIVE: To evaluate longitudinal changes in pulmonary function in infants with respiratory distress syndrome (RDS) treated with oxygen, positive pressure ventilation and synthetic surfactant (Exosurf). METHODS: Serial pulmonary function tests were performed in surfactant-treated infants [mean +/- SD birth weight (BW) = 1,112 +/- 276 g, gestational age (GA) = 29 +/- 3 weeks] at postnatal ages: <3 days, 1, 2, 3, 4 and 6-8 weeks until term postmenstrual age (PMA). Tidal volume, pulmonary compliance (C(L)), pulmonary resistance (R(T)) and flow-resistive work were analyzed following simultaneous measurements of airflow and transpulmonary pressure signals. Serial FRC measurements were made in a randomly selected group. Results: Prior to 28 weeks' PMA, C(L) was unchanged irrespective of GA. At age 1 week the likelihood ratio (LR) for bronchopulmonary dysplasia (BPD) based on C(L), R(T) and GA was predicted to be >90% for those with BW <750 g (LR >100) as compared to <10% probability (LR = 0.3) for infants >1,500 g. Significant linear increase in C(L) to PMA was evident >28 weeks' PMA (r = 0.86, p < 0.01) at 0.17 ml/cm H2O/kg/week. By term PMA, mean C(L) was 2.60 +/- 0.07 ml/cm H2O. Improvements in FRC of preterm infants with RDS who recovered occur at a more rapid rate ( approximately 25 ml/kg) compared to those who developed BPD ( approximately 20 ml/kg). CONCLUSIONS: Slow but incremental postnatal pulmonary improvement, minimal <28 weeks' PMA, were comparable for all infants. Along with diminished FRC, these changes reflect persistent deleterious effects of positive pressure ventilation, alveolar hyperoxia and unrecognized pulmonary overdistension.
Authors:
Vinod K Bhutani; Frank W Bowen; Emidio M Sivieri
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2005-06-01
Journal Detail:
Title:  Biology of the neonate     Volume:  87     ISSN:  0006-3126     ISO Abbreviation:  Biol. Neonate     Publication Date:  2005  
Date Detail:
Created Date:  2005-06-29     Completed Date:  2005-08-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0247551     Medline TA:  Biol Neonate     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  323-31     Citation Subset:  IM    
Copyright Information:
Copyright 2005 S. Karger AG, Basel
Affiliation:
Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA 94305-5731, USA. bhutani@stanford.edu
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MeSH Terms
Descriptor/Qualifier:
Continuous Positive Airway Pressure
Drug Combinations
Fatty Alcohols / administration & dosage,  therapeutic use*
Humans
Infant, Newborn
Infant, Premature
Longitudinal Studies
Oxygen / administration & dosage
Phosphorylcholine / administration & dosage,  therapeutic use*
Polyethylene Glycols / administration & dosage,  therapeutic use*
Pulmonary Surfactants / administration & dosage,  therapeutic use*
Respiratory Distress Syndrome, Newborn / drug therapy*,  physiopathology*
Respiratory Function Tests
Retrospective Studies
Chemical
Reg. No./Substance:
0/Drug Combinations; 0/Fatty Alcohols; 0/Polyethylene Glycols; 0/Pulmonary Surfactants; 107-73-3/Phosphorylcholine; 7782-44-7/Oxygen; 99732-49-7/Exosurf

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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