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Neonatology pp 809-822 | Cite as

Surfactant Metabolism in Neonatal Lung Diseases

  • Virgilio P. Carnielli
  • Paola E. Cogo
Reference work entry

Abstract

Surfactant treatments have been the standard of care for infants with respiratory distress syndrome (RDS) since the early 1990s. The development of surfactant is one of the great success stories in neonatal care because the therapy specifically treats surfactant deficiency and changes the pathophysiology and outcome of RDS. However, deficiency or dysfunction of pulmonary surfactant still persist in selected preterm and term infants and contribute to the pathogenesis of several respiratory diseases in the newborn. After a short review of pulmonary surfactant, including the role of surfactant in selected neonatal respiratory conditions, we describe a series of studies made by applying two recently developed methods to measure surfactant kinetics. In a first set of studies which we call “endogenous studies” by using stable isotope-labelled 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 a second set of studies, named “exogenous studies,” with the use of stable isotope-labelled phosphadylcholine (PC) tracer given endotracheally, we could estimate surfactant DSPC pool size and half-life. Major finding of the surfactant kinetic studies in the newborn infant can be summarized as follow: (a) the de novo synthesis rates and turnover rates of surfactant disaturated phosphatidylcholine (DSPC) in preterm infants with respiratory distress syndrome (RDS) are very low, (b) in preterm with RDS pool size is very small and half-life much longer in comparison with animal studies, (c) patients recovering from RDS who required higher CPAP setting after extubation or reintubation had lower amount of intrapulmonary surfactant that 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 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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Authors and Affiliations

  1. 1.Division of Neonatology, Salesi HospitalPolytechnic University of MarcheAnconaItaly
  2. 2.Division of Pediatrics, Department of MedicineS. Maria della Misericordia University Hospital, University of UdineUdineItaly

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