Surfactant Treatment of Neonates With Respiratory Failure and Group B Streptococcal Infection

Herting, Egbert; Gefeller, Olaf; Land, Matthias; Sonderen, Loekie van; Harms, Karsten; Robertson, Bengt

doi:10.1542/peds.106.5.957

Cited by 136 publications

(89 citation statements)

References 28 publications

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“…37 Exogenous surfactant therapy has been shown to be beneficial 70% of the time in patients with ARDS. 38 In a randomized, controlled trial using beractant in forty newborns with MAS, Findley et al 39 demonstrated a significant reduction in the need for extracorporeal membrane oxygenation (ECMO) therapy. Lotze et al 40 performed a large, multicenter study in 328 term newborns with ARDS secondary to MAS, sepsis-induced ARDS or persistent pulmonary hypertension.…”

Section: Surfactant Therapy and Nasal Continuous Positive Airway Presmentioning

confidence: 99%

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Surfactant therapy in preterm infants with respiratory distress syndrome and in near-term or term newborns with acute RDS

Ramanathan

2006

J Perinatol

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Many different surfactant preparations derived from animal sources, as well as synthetic surfactants, are available for the treatment of preterm infants with respiratory distress syndrome (RDS). Natural, modified surfactants containing surfactant-associated proteins appear to be more effective than non-protein-containing synthetic surfactants. Comparative trials with poractant alfa at a higher initial dose of 200 mg/kg appear to be associated with rapid weaning of FiO 2 , less need for additional doses, and decreased mortality in infants <32 weeks gestation when compared with beractant. Early rescue (<30 min of age) surfactant therapy is an effective method to minimize over treatment of some preterm infants who may not develop RDS. Surfactant therapy followed by rapid extubation to nasal ventilation appears to be more beneficial than continued mechanical ventilation. In near-term or term newborns with acute RDS, surfactant therapy has been shown to be 70% effective in improving respiratory failure.

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Section: Surfactant Therapy and Nasal Continuous Positive Airway Presmentioning

confidence: 99%

“…38 Newborns with congenital diaphragmatic hernia (CDH) have been shown to have surfactant abnormalities. In a multicenter, randomized study, Anderson et al 43 demonstrated significant adverse outcomes among infants treated with surfactant.…”

Section: Surfactant Therapy and Nasal Continuous Positive Airway Presmentioning

confidence: 99%

Surfactant therapy in preterm infants with respiratory distress syndrome and in near-term or term newborns with acute RDS

Ramanathan

2006

J Perinatol

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“…It is interesting to speculate that a lack of DPPC inhibition of beta-h/c toxicity may in part explain the increased incidence and severity of GBS pneumonia and sepsis in premature, surfactant-deficient neonates (4). In the future, adjunctive therapies designed to neutralize beta-h/c could prove of use in management of neonatal GBS infections; indeed, surfactant therapy appears to exert a beneficial effect against pneumonia and lung injury produced by the organism (30). Neutralizing antibodies against the GBS beta-h/c do not develop as a consequence of natural infection nor have they been raised successfully to crude GBS beta-h/c preparations (31).…”

Section: Beta-hemolysin/cytolysinmentioning

confidence: 99%

Extracellular virulence factors of group B Streptococci

Liu

Nizet²

2004

Front Biosci

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“…60 Neonatal pneumonia Pneumonia in children and newborn infants may be associated with surfactant dysfunction and acute RDS. [61][62][63][64][65][66] There are studies involving a small number of neonates who have been treated with rescue surfactant replacement for sepsis and pneumonia that have shown improved gas exchange compared with no surfactant treatment. 61,63,64,67 -69 Verlato et al 70 used the 'exogenous' tracing approach with an endotracheal administration of 13 C-labeled DPPC to study surfactant kinetics in full term with pneumonia, and in preterms with RDS.…”

Section: Surfactant Status Of Preterm Infants Recovering From Rdsmentioning

confidence: 99%

Pulmonary surfactant kinetics of the newborn infant: novel insights from studies with stable isotopes

et al. 2009

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Deficiency or dysfunction of the pulmonary surfactant plays a critical role in the pathogenesis of respiratory diseases of the newborn. After a short review of the pulmonary surfactant, including its role in selected neonatal respiratory conditions, we describe a series of studies conducted by applying two recently developed methods to measure surfactant kinetics. In the first set of studies, namely 'endogenous studies', which used stable isotope-labeled intravenous surfactant precursors, we have shown the feasibility of measuring surfactant synthesis and kinetics in infants using several metabolic precursors, including plasma glucose, plasma fatty acids and body water. In the second set of studies, namely 'exogenous studies', which used a stable isotope-labeled phosphatidylcholine (PC) tracer given endotracheally, we estimated the surfactant disaturated phosphatidylcholine (DSPC) pool size and half-life. The major findings of our studies are presented here and can be summarized as follows: (a) the de novo synthesis and turnover rates of the surfactant (DSPC) in preterm infants with respiratory distress syndrome (RDS) are very low with either precursor; (b) in preterm infants with RDS, pool size is very small and half-life much longer than what has been reported in animal studies; (c) patients recovering from RDS who required higher continuous positive airway pressure pressure after extubation or reintubation have a lower level of intrapulmonary surfactant than those who did well after extubation; (d) term newborn infants with pneumonia have greatly accelerated surfactant catabolism; and (e) infants with uncomplicated congenital diaphragmatic hernia (CDH) and on conventional mechanical ventilation have normal surfactant synthesis, but those requiring extracorporeal membrane oxygenated (ECMO) do not. Information obtained from these studies in infants will help to better tailor exogenous surfactant treatment in neonatal lung diseases.

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Surfactant Treatment of Neonates With Respiratory Failure and Group B Streptococcal Infection

Cited by 136 publications

References 28 publications

Surfactant therapy in preterm infants with respiratory distress syndrome and in near-term or term newborns with acute RDS

Surfactant therapy in preterm infants with respiratory distress syndrome and in near-term or term newborns with acute RDS

Extracellular virulence factors of group B Streptococci

Pulmonary surfactant kinetics of the newborn infant: novel insights from studies with stable isotopes

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