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Stable microbubble test for predicting the risk of respiratory distress syndrome: I. Comparisons with other predictors of fetal lung maturity in amniotic fluid

  • Neonatology
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Abstract

With the advent of surfactant replacement therapy, there is an increasing need for a rapid test of predicting the development of respiratory distress syndrome (RDS). We evaluated the clinical usefulness of the stable microbubble (SM) test in predicting the development of RDS by comparison with other tests in amniotic fluid samples obtained within 12h before delivery from 40 pregnancies between 23–35 weeks of gestation. These tests included the lecithin/sphingomyelin (L/S) ratio, disaturated phosphatidylcholine/sphingomyelin (DSPC/S) ratio, concentrations of lecithin, DSPC, and surfactant-associated proteins A and B, C (SP-A, SP-B,C). The cut-off value of each test for predicting RDS was determined at a point of maximum diagnostic accuracy. The overall diagnostic accuracy of the SM test was similar to that of other tests. However, both the SM test and the SP-B,C concentration had positive predictive values of 100%. We conclude that the rapid (<10 min) and reliable information obtained by this test should encourage its use in defining a population of neonates with surfactant deficiency in a multicentre trial of prophylactic surfactant therapy.

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Abbreviations

RDS:

respiratory distress syndrome

L/S ratio:

lecithin/sphingomyelin ratio

DSPC:

disaturated phosphatidylcholine

DSPC/S ratio:

disaturated phosphatidylcholine/sphingomyelin ratio

SP-A:

surfactant-associated protein A

SP-B,C:

surfactant-associated protein B, C

SM:

stable microbulbble

References

  1. Armitage P (1971) Statistical methods in medical research. Blackwell Scientific Publications, Oxford, pp 127

    Google Scholar 

  2. Bhagwanani SG, Fahmy D, Turnbull AC (1972) Prediction of neonatal respiratory distress by estimation of amniotic fluid lecithin. Lancet I:159–162

    Google Scholar 

  3. Chida S, Phelps DS, Cordle C, Soll R, Floros J, Taeusch HW (1988) Surfactant-associated proteins in tracheal aspirates of neonates with respiratory distress syndrome after surfactant therapy. Am Rev Respir Dis 137:943–947

    PubMed  Google Scholar 

  4. Chida S, Fujiwara T, Takahashi A, Kanehama S, Kaneko J (1991) Precision and reliability of stable microbubble test as a predictor of respiratory distress syndrome. Acta Paediatr Jpn 33:15–19

    PubMed  Google Scholar 

  5. Chida S, Fujiwara T, Konishi M, Takahashi H, Sasaki M (1992) Stable microbubble test for predicting the risk of respiratory distress syndrome: II. Prospective evaluation of the test on amniotic fluid and gastric aspirate. Eur J Pediatr 152:151–155

    Google Scholar 

  6. Clements JA, Platzker ACG, Tierney DE, Hobel CJ, Creasy RK, Margolis AJ, Thibeault DW, Tooley WH, Oh W (1972) Assessment of the risk of the respiratory-distress syndrome by a rapid test for surfactant in amniotic fluid. N Engl J Med 286: 1077–1081

    PubMed  Google Scholar 

  7. Fujiwara T (1984) Surfactant replacement in neonatal RDS. In: Robertson B, Van Golde LMG, Batenburg JJ (eds) Pulmonary surfactant. Elsevier, Amsterdam, pp 479–503

    Google Scholar 

  8. Fujiwara T, Takahashi H (1989) Assessment of fetal lung maturity: stable microbubble test in amniotic fluid and gastric aspirate. J Jpn Med Assoc 101:281–288 (in Japanese)

    Google Scholar 

  9. Gluck L, Kulovich MV, Borer RC, Brenner PH, Anderson CG, Spellacy WN (1971) Diagnosis of the respiratory distress syndrome by amniocentesis. Am J Obstet Gynecol 109:440–445

    PubMed  Google Scholar 

  10. Gonen R, Tal J, Oettinger M, Samberg I, Sharf M, Yechieli H, Boxer J (1978) Assessment of fetal lung maturity by a microviscosimeter. Obstet Gynecol 51:422–425

    PubMed  Google Scholar 

  11. Hallman M, Teramo K (1981) Measurement of the lecithin/sphingomyelin ratio and phosphatidylglycerol in amniotic fluid: an accurate method for the assessment of fetal lung maturity. Br J Obstet Gynaecol 88:806–813

    PubMed  Google Scholar 

  12. Hallman M, Kulovich M, Kirkpatrick E, Sugarman RG, Gluck L (1976) Phosphatidylinositol and phosphatidylglycerol in amniotic fluid: indices of lung maturity. Am J Obstet Gynecol 125:613–617

    PubMed  Google Scholar 

  13. Hallman M, Merritt TA, Jarvenpaa A-L, Boynton B, Mannino F, Gluck L, Moore T, Edwards D (1985) Exogenous human surfactant for treatment of severe respiratory distress syndrome: a randomized prospective clinical trial. J Pediatr 106: 963–969

    PubMed  Google Scholar 

  14. Hallman M, Arjomaa P, Mizumoto M, Akino T (1988) Surfactant proteins in the diagnosis of fetal lung maturity: I. predictive accuracy of the 35 kD protein, the lecithin/sphingomyelin ratio, and phosphatidylglycerol. Am J Obstet Gynecol 158: 531–535

    PubMed  Google Scholar 

  15. Katyal SL, Amenta JS, Singh G, Silverman JA (1984) Deficient lung surfactant apoproteins in amniotic fluid with mature phospholipid profile from diabetic pregnancies. Am J Obstet Gynecol 148:48–53

    PubMed  Google Scholar 

  16. King RJ, Ruch J, Gikas EG, Platzker ACG, Creasy RK (1975) Appearance of apoproteins of pulmonary surfactant in human amniotic fluid. J Appl Physiol 39:735–741

    PubMed  Google Scholar 

  17. Kuroki Y, Takahashi H, Fukuda Y, Mikawa M, Inagawa A, Fujimoto S, Akino T (1985) Two-site “simultaneous” immunoassay with monoclonal antibodies for the determination of surfactant apoproteins in human amniotic fluid. Pediatr Res 19: 1017–1020

    PubMed  Google Scholar 

  18. Mason RJ, Nellenbogen J, Clements JA (1976) Isolation of disaturated phosphatidylcholine with osmium tetroxide. J Lipid Res 17:281–284

    PubMed  Google Scholar 

  19. McMahan MJ, Mimouni F, Miodovnik M, Hull WM, Whitsett JA (1987) Surfactant associated protein (SAP-35) in amniotic fluid from diabetic and nondiabetic pregnancies. Obstet Gynecol 70:94–98

    PubMed  Google Scholar 

  20. Morita T, Fujiwara T (1984) Prediction of RDS by the measurement of DSPC/S in amniotic fluid. Jpn J Perinatal Med 9:757–763 (in Japanese)

    Google Scholar 

  21. Pattle RE (1955) Properties, function and origin of the alveolar lining layer. Nature 175:1125–1126

    PubMed  Google Scholar 

  22. Pattle RE, Kratzing CC, Parkinson CE, Graves L, Robertson RD, Robards GJ, Currie JO, Parsons JH, Sutherland PD (1979) Maturity of fetal lungs tested by production of stable microbubbles in amniotic fluid. Br J Obstet Gynaecol 86:615–622

    PubMed  Google Scholar 

  23. Shelley SA, Balis JU, Paciga JE, Knuppel RA, Ruffolo EH, Bouis PJ (1982) Surfactant “apoproteins” in human amniotic fluid: an enzyme-linked immunosorbent assay for the prenatal assessment of lung maturity. Am J Obstet Gynecol 144:224–228

    PubMed  Google Scholar 

  24. Snyder JM, Kwun JE, O'Bien, JA, Rosenfeld CR, Odom MJ (1988) The concentration of the 35-kDa surfactant apoprotein in amniotic fluid from normal and diabetic pregnancies. Pediatr Res 24:728–734

    PubMed  Google Scholar 

  25. Taeusch HW, Keough KMW, Williams M, Slavin R, Steele E, Lee AS, Phelps D, Kariel N, Floros J, Avery ME (1986) Characterization of bovine surfactant for neonates with respiratory distress syndrome. Pediatrics 77:572–581

    PubMed  Google Scholar 

  26. Takahashi A, Fujiwara T (1986) Proteolipid in bovine lung surfactant: its roll in surfactant function. Biochem Biophys Res Comm 135:527–532

    PubMed  Google Scholar 

  27. Torday J, Carson L, Lawson EE (1979) Saturated phosphatidylcholine in amniotic fluid and prediction of the respiratory distress syndrome. N Engl J Med 301:1013–1018

    PubMed  Google Scholar 

  28. Whitsett JA, Ohning BL, Ross G, Meuth J, Weaver T, Holm BA, Shapiro DL, Notter RH (1986) Hydrophobic surfactant-associated protein in whole lung surfactant and its importance for biophysical activity in lung surfactant extracts used for replacement therapy. Pediatr Res 20:460–467

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Paediatrics, Iwate Medical University, School of Medicine, 19-1 Uchimaru, 020, Morioka, Japan

    S. Chida & T. Fujiwara

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  1. S. Chida
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  2. T. Fujiwara
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Chida, S., Fujiwara, T. Stable microbubble test for predicting the risk of respiratory distress syndrome: I. Comparisons with other predictors of fetal lung maturity in amniotic fluid. Eur J Pediatr 152, 148–151 (1993). https://doi.org/10.1007/BF02072493

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  • DOI: https://doi.org/10.1007/BF02072493

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