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European Journal of Pediatrics

, Volume 149, Issue 10, pp 727–729 | Cite as

Surfactant treatment for respiratory distress syndrome following prolonged rupture of membranes

  • T. R. J. Tubman
  • H. L. Halliday
Neonatology

Abstract

Surfactant replacement for respiratory distress syndrome (RDS) following very prolonged rupture of the membranes (PROM) is of uncertain value. Seven preterm babies born after PROM (median 48 days, range 22–61 days) were compared with 14 babies without PROM. All had clinical and radiological evidence of severe RDS, requiring mechanical ventilation with inspired oxygen concentrations ≥60%. Indices of oxygenation and “compliance” were compared before and serially up to 4h after surfactant treatment. Before treatment the PROM babies had more severe lung disease, based upon higher inspired oxygen concentration and mean airway pressure, and lower arterial/alveolar oxygen tension ratio and ventilator efficiency index. These indices were significantly worse in the PROM group than the comparison group at all times after treatment. The poor response of the PROM group, perhaps because of pulmonary hypoplasia, suggests that surfactant replacement may not be beneficial for RDS in these babies.

Key words

Surfactant Prolonged membrane rupture Pulmonary hypoplasia 

Abbreviations

a/A PO2

arterial/alveolar oxygen tension ratio

FiO2

fraction of inspired oxygen

PROM

prolonged rupture of the membranes

RDS

respiratory distress syndrome

VEI

ventilator efficiency index

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References

  1. 1.
    Askenazi SS, Perlman M (1979) Pulmonary hypoplasia: lung weight and radial alveolar count as criteria of diagnosis. Arch Dis Child 54:614–618PubMedGoogle Scholar
  2. 2.
    Collaborative European Multicentre Study Group (1988) Surfactant replacement therapy in severe neonatal respiratory distress syndrome; an international randomised clinical trial. Pediatrics 82:683–691Google Scholar
  3. 3.
    Halliday HL, McCord FB, McClure BG, Reid MMcC (1989) Acute effects of instillation of surfactant in severe respiratory distress syndrome. Arch Dis Child 64:13–16PubMedGoogle Scholar
  4. 4.
    Hislop A, Wigglesworth JS, Desai R, Aber V (1987) The effects of preterm delivery and mechanical ventilation on human lung growth. Early Hum Dev 15:147–164CrossRefPubMedGoogle Scholar
  5. 5.
    McCord FB, Curstedt T, Halliday HL, McClure BG, Reid, MMcC, Robertson B (1988) Surfactant treatment and incidence of intraventricular haemorrhage in severe respiratory distress syndrome. Arch Dis Child 63:10–16PubMedGoogle Scholar
  6. 6.
    McIntosh N (1988) Dry lung syndrome after oligohydramnios. Arch Dis Child 63:190–193PubMedGoogle Scholar
  7. 7.
    Mead PB (1983) Premature rupture of the membranes. In: Chiswick ML (ed) Recent advances in perinatal medicine, vol. 1. Churchill Livingstone, Edinburgh, pp 77–84Google Scholar
  8. 8.
    Nakamura Y, Yamamoto I, Funatsu Y, Motomura K, Fukuda S, Hashimoto T, Morimatsu M (1988) Decreased surfactant level in the lung with oligohydramnios: a morphometric and biochemical study. J Pediatr 112:471–474PubMedGoogle Scholar
  9. 9.
    Noack G, Berggren P, Curstedt T, Grossman G, Herin P, Mortensson W, Nilson R, Robertson B (1987) Severe neonatal respiratory distress syndrome treated with the isolated phospholipid fraction of natural surfactant. Acta Paediatr Scand 76:697–705PubMedGoogle Scholar
  10. 10.
    Notter RH, Egan EA, Kwong MS, Holm BA, Shapiro DL (1985) Lung surfactant replacement in premature lambs with extracted lipids from bovine lung lavage: effects of dose, dispersion technique, and gestational age. Pediatr Res 19:569–577PubMedGoogle Scholar
  11. 11.
    Perlman M, Williams J, Hirsch M (1976) Neonatal pulmonary hypoplasia after prolonged leakage of amniotic fluid. Arch Dis Child 51:349–353PubMedGoogle Scholar
  12. 12.
    Thibeault DW, Beatty EC, Hall RT, Bowen SK, O'Neill DH (1985) Neonatal pulmonary hypoplasia with premature rupture of fetal membranes and oligohydramnios. J Pediatr 107:273–277PubMedGoogle Scholar
  13. 13.
    Wigglesworth JS, Desai R, Guerrini P (1981) Fetal lung hypoplasia: biochemical and structural variations and their possible significance. Arch Dis Child 56:606–615PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • T. R. J. Tubman
    • 1
  • H. L. Halliday
    • 2
  1. 1.NICU, Royal Maternity HospitalQueen's University BelfastBelfastNorthern Ireland
  2. 2.Department of Child HealthQueen's University BelfastBelfastNorthern Ireland

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