Late administration of surfactant replacement therapy increases surfactant protein-B content: a randomized pilot study.

Abstract

BACKGROUND:

Surfactant dysfunction may contribute to the development of bronchopulmonary dysplasia (BPD) in persistently ventilated preterm infants. We conducted a multicenter randomized, blinded, pilot study to assess the safety and efficacy of late administration of doses of a surfactant protein-B (SP-B)-containing surfactant (calfactant) in combination with prolonged inhaled nitric oxide (iNO) in infants ≤1,000 g birth weight (BW).

METHODS:

We randomized 85 preterm infants ventilated at 7-14 d after birth to receive either late administration of surfactant (up to 5 doses) plus prolonged iNO or iNO alone. Large aggregate surfactant was isolated from daily tracheal aspirates (TAs) for measurement of SP-B content, total protein, and phospholipid (PL).

RESULTS:

Late administration of surfactant had minimal acute adverse effects. Clinical status as well as surfactant recovery and SP-B content in tracheal aspirate were transiently improved as compared to the controls; these effects waned after 1 d. The change in SP-B content with surfactant dosing was positively correlated with SP-B levels during treatment (r = 0.50, P = 0.02).

CONCLUSION:

Low SP-B values increased with calfactant administration, but the relationship of this response to SP-B levels suggests that degradation is a contributing mechanism for SP-B deficiency and surfactant dysfunction. We conclude that late therapy with surfactant in combination with iNO is safe and transiently increases surfactant SP-B content, possibly leading to improved short- and long-term respiratory outcomes.

• Authors: Roberta L Keller, Jeffrey D Merrill, Dennis M Black, Robin H Steinhorn, Eric C Eichenwald, David J Durand, Rita M Ryan, William E Truog, Sherry E Courtney, Philip L Ballard, Roberta A Ballard
• Journal: Pediatric research (Pediatr Res) Vol. 72 Issue 6 Pg. 613-9 (Dec 2012) ISSN: 1530-0447 [Electronic] United States
• PMID: 23037875 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Pulmonary Surfactant-Associated Protein B
• Pulmonary Surfactants

Topics

• Humans
• Infant, Newborn
• Infant, Premature
• Pilot Projects
• Pulmonary Surfactant-Associated Protein B (deficiency)
• Pulmonary Surfactants (administration & dosage)