Randomized trial of artificial surfactant (ALEC) given at birth to babies from 23 to 34 weeks gestation

Morley, C J; Greenough, Anne; Miller, Nigel; Bangham, A. D.; Pool, J; Wood, Susan; South, Mike; Davis, John A.; Vyas, H

doi:10.1016/s0378-3782(88)80056-2

Cited by 52 publications

(25 citation statements)

References 32 publications

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“…Artificial Lung Expanding Compound (ALEC) (Britannia Pharmaceuticals, Redhill, Surrey, UK) is a mixture of DPPC and unsaturated PG 7:3 (w/w), suspended in cold saline [295]. The name of the drug is an abbreviation, but also happens to be the first name of one of its inventors, Alec Bangham.…”

Section: Surfactant Currently Used In Clinical Practicementioning

confidence: 99%

“…ALEC has been evaluated in preterm newborn animals, with conflicting results, some investigators reporting a moderate effect on lung compliance [297], others denying a physiological effect [298]. ALEC does not seem to be effective in babies with established RDS [299], but improves lung function, reduces mortality, and lowers the incidence of intraventricular haemorrhage when administered prophylactically, especially in babies with a gestational age of less than 30 weeks [295,300]. Increased lung compliance has been reported in preterm babies treated with ALEC at birth, but this was not statistically significant until 6 h after administration of the drug [301].…”

Section: Surfactant Currently Used In Clinical Practicementioning

confidence: 99%

See 1 more Smart Citation

The proteins of the surfactant system

Johansson¹,

Curstedt²,

Robertson³

1994

Eur Respir J

203

143

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T Th he e p pr ro ot te ei in ns s o of f t th he e s su ur rf fa ac ct ta an nt t s sy ys st te em m SP-B is a 79-residue polypeptide that contains three intrachain disulphide bridges. It exists mainly as a homodimer, which is strongly positively charged and may selectively remove anionic and unsaturated lipid species from the alveolar surface film, thereby increasing surface pressure.SP-C is a mainly α-helical, extraordinarily hydrophobic polypeptide containing 35 amino acid residues and covalently linked palmitoyl groups. Its α-helical portion is inserted into surfactant lipid bilayers. SP-C accelerates the adsorption of lipid bilayers to an interfacial monolayer. In babies with respiratory distress syndrome, the clinical response to treatment with surfactant containing SP-B and SP-C is much faster than in babies treated with protein-free synthetic surfactant.We speculate that, in the near future, surfactant preparations based on recombinant hydrophobic proteins will be available for clinical use.

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Section: Surfactant Currently Used In Clinical Practicementioning

confidence: 99%

Section: Surfactant Currently Used In Clinical Practicementioning

confidence: 99%

The proteins of the surfactant system

Johansson¹,

Curstedt²,

Robertson³

1994

Eur Respir J

203

143

View full text Add to dashboard Cite

show abstract

“…Surfactant treatment decreases neonatal mortality and incidence o f pulmonary inter stitial emphysema and pneumothorax in pre mature infants with respiratory distress syn drome (RDS) [1-7], Moreover, this therapy is beneficial to the outcome with respect to oxy gen dependency at 28 days [7] and oxygen dependency at expected date o f delivery [3], Surfactant replacement therapy also re sults in early improvement in oxygen satura tion and reduction in mean airway pressure [1-8], With natural surfactant preparations, such as modified porcine surfactant (Curo surf), a dramatic improvement in oxygena tion, as reflected by a nearly threefold in crease of partial arterial pressure of oxygen/ fraction o f inspired oxygen (FiCb) ratio, has been reported [2], However, despite the clini-cal improvement, reports about changes in pulmonary mechanics in such neonates have been less convincing [9][10][11][12][13][14][15][16]. Thus, studies on lung mechanics after surfactant treatment in human neonates have been less conclusive than experimental data obtained from imma ture animals [17,18].…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Effects after Surfactant Treatment in Premature Infants with Severe Respiratory Distress Syndrome

Farstad¹,

Bratlid²

1995

Neonatology

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To understand the mechanisms behind the improved oxygenation after intratracheal surfactant instillation, the immediate effects on lung volume and pulmonary mechanics were analyzed. All infants studied were enrolled in multicenter trials in which surfactant therapy was instituted according to a rescue protocol. Infants received either synthetic surfactant (Exosurf) or modified porcine surfactant (Curosurf). Measurements of lung volume and pulmonary mechanics were successfully performed in 12 patients with a birth weight of 1.3 ± (SD) 0.6 (range 0.7-2.7) kg, and a gestational age of 28.3 ± (SD) 1.4 weeks. Functional residual capacity (FRC) and pulmonary mechanics were measured during mechanical ventilation. The FRC increased significantly by 70% (median), from 7.10 ± (SD) 2.8 ml/kg to 11.5 ± 3.3 ml/kg after surfactant instillation. However, a concomitant decrease in specific compliance was also seen. These findings could suggest that this immediate increase in FRC is initially nonuniform. However, since no significant correlation between changes in FRC and improvement in arterial-to-alveolar oxygen tension ratio is seen, other effects of surfactant must also be considered. These could include local and/or systemic changes in hemodynamics, such as decreased shunting as well as various effects on gas diffusion.

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“…37 The surfactant had little effect in infants above 29 weeks gestation and was most beneficial in infants under 30 weeks gestation (67 controls and 69 surfactant treated infants). This artificial surfactant significantly reduced the inspired oxygen and peak ventilator pressure requirements during the first 96 hours, the incidence of intraventricular hemorrhage from 40% to 19%, the overall mortality from 36% to 17%, the need for more than 28 days oxygen from 37% to 21% and the use of pancuronium in ventilated infants from 52% to 27%.…”

Section: Effects Of Synthetic Surfactants On Preterm Infant Lungsmentioning

confidence: 98%

Effects of surfactants on preterm infant lungs

Pacifici¹

2015

Medical Express

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Randomized trial of artificial surfactant (ALEC) given at birth to babies from 23 to 34 weeks gestation

Cited by 52 publications

References 32 publications

The proteins of the surfactant system

The proteins of the surfactant system

Pulmonary Effects after Surfactant Treatment in Premature Infants with Severe Respiratory Distress Syndrome

Effects of surfactants on preterm infant lungs

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