Bronchoalveolar lavage surfactant protein a, B, and d concentrations in preterm infants ventilated for respiratory distress syndrome receiving natural and synthetic surfactants

Pediatr Res. 2003 Apr;53(4):663-70. doi: 10.1203/01.PDR.0000054653.89527.F8. Epub 2003 Jan 15.

Abstract

Surfactant proteins (SPs) play an important role in surfactant metabolism and function. Understanding their relative contribution to clinical outcome remains incomplete. Exogenous surfactants differ in their SP content and physiologic effects. The aims of this study were to measure bronchoalveolar lavage (BAL) SP concentrations from preterm infants ventilated for respiratory distress syndrome and to assess their association with clinical outcome. Fifty preterm infants randomized to receive a natural or synthetic surfactant were lavaged each day for the first week and twice weekly thereafter using a standardized nonbronchoscopic technique. BAL SP-A, SP-B, and SP-D concentrations were measured using ELISA. Median BAL SP-A, SP-B, and SP-D concentrations for the whole cohort rose significantly during the first postnatal week (p < 0.05). SP-A concentration did not differ between outcome groups. BAL SP-B concentration rose significantly in lungs that were not supplemented with SP-B. Infants dying had significantly lower BAL SP-B concentrations on d 2 and 6 compared with survivors. BAL SP-D concentrations were significantly lower on d 2 and 3 among infants in supplemental oxygen on d 28 compared with those in air. BAL SP-A and SP-D concentrations did not differ significantly between infants randomized to receive a natural or synthetic surfactant. Lower BAL SP-B and SP-D but not SP-A concentrations were associated with worse clinical prognosis.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bronchoalveolar Lavage Fluid / chemistry
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Predictive Value of Tests
  • Prognosis
  • Pulmonary Surfactant-Associated Protein A / analysis
  • Pulmonary Surfactant-Associated Protein A / pharmacokinetics
  • Pulmonary Surfactant-Associated Protein B / analysis
  • Pulmonary Surfactant-Associated Protein B / pharmacokinetics
  • Pulmonary Surfactant-Associated Protein D / analysis
  • Pulmonary Surfactant-Associated Protein D / pharmacokinetics
  • Pulmonary Surfactant-Associated Proteins / analysis
  • Pulmonary Surfactant-Associated Proteins / pharmacokinetics*
  • Respiration, Artificial
  • Respiratory Distress Syndrome, Newborn / drug therapy*
  • Respiratory Distress Syndrome, Newborn / metabolism*
  • Respiratory Distress Syndrome, Newborn / mortality
  • Survival Rate

Substances

  • Pulmonary Surfactant-Associated Protein A
  • Pulmonary Surfactant-Associated Protein B
  • Pulmonary Surfactant-Associated Protein D
  • Pulmonary Surfactant-Associated Proteins