The lungs in immature infants: How important is surfactant therapy in preventing chronic lung problems?

Abstract

Seventy-five premature infants weighing between 600 and 3200 g were studied over a period of 1 year. All of the infants received surfactant therapy for hyaline membrane disease immediately after birth and, thereafter, up to four doses every 6 h. The roentgenographic findings in all patients were documented at birth and at 2 days, 7-10 days, and 21-28 days of life. Larger babies responded to surfactant therapy better than did smaller infants. The smaller infants, even after initial clearing, were prone to develop pulmonary edema and the bubbly lungs of bronchopulmonary dysplasia. These data suggest that small infants, while initially responding to surfactant therapy with clearing of their lungs, are still at considerable risk of developing chronic lung disease in the form of pulmonary edema and bronchopulmonary dysplasia. An explanation is offered for why this occurs; at the same time it is suggested that, in view of our findings and those in the literature, the problems of pulmonary edema and bubbly lungs be more clearly separated.

Interstitial pneumonia pattern on day 7 chest radiograph predicts bronchopulmonary dysplasia in preterm infants

“…Furthermore, interstitial changes on chest radiograph are less influenced by inflation status, which will be variable in the preterm infants. Interstitial changes on chest radiograph indicate lung injury, including airway and pulmonary vascular damages and interstitial edema [17]. The presence of interstitial changes on chest radiograph is significantly associated with BPD [10, 11, 18] or adverse respiratory outcomes [19].…”

“…However, we did not evaluate cystic changes in this study because cystic changes on chest radiographs were more difficult to distinguish from other diseases, such as infection, sequelae of pulmonary hemorrhage, and pulmonary interstitial emphysema [16]. In addition, cystic changes on chest radiograph represent chronic pathological changes and appear later [17]. …”

Decreased Free Water Clearance Is Associated with Worse Respiratory Outcomes in Premature Infants

“…All chest radiographs, obtained according to clinical indications were assessed by a pediatric radiologist. BPD findings were classified as hazy to opaque or bubbly chest images [23].…”

Frequency and clinical correlates of radiographic patterns of bronchopulmonary dysplasia in very low birth weight infants by term age

“…Chest X-rays taken before the sixth day were excluded as the radiographic pattern of resolving RDS cannot be distinguished from LLS. Fifty-nine (72%) infants had at least one chest radiograph taken after the fifth day, and the median number of radiographs available per infant was 5 (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Of the 368 available radiographs, 316 were taken between 6 days' chronological age and 40 weeks' PMA and 148 at the diagnostic time points, namely the 5th-15th day, 28th (21st-35th) day, 36 (35-37) weeks PMA and term (37-43 weeks PMA).…”

“…Even VLBW infants without severe respiratory distress shortly after birth may develop progressive signs respiratory failure, need for O 2 supplementation and abnormal chest X-rays over the first weeks of life [1,16]. Two radiographic patterns have been presented: the hazy-to-opaque lungs primarily due to capillary damage and pulmonary oedema (the leaky lung syndrome (LLS)) and the bubbly changes [19]. The interpretation of radiographs is challenging.…”