Dosing of porcine surfactant: effect on kinetics and gas exchange in respiratory distress syndrome

Pediatrics. 2009 Nov;124(5):e950-7. doi: 10.1542/peds.2009-0126. Epub 2009 Oct 12.

Abstract

Objective: The goal was to study exogenous surfactant disaturated phosphatidylcholine (DSPC) kinetics in preterm infants with respiratory distress syndrome (RDS) who were treated with 100 or 200 mg/kg porcine surfactant.

Methods: Sixty-one preterm infants with RDS undergoing mechanical ventilation received, within 24 hours after birth, 100 mg/kg (N = 40) or 200 mg/kg (N = 21) porcine surfactant mixed with [U-(13)C]dipalmitoylphosphatidylcholine. Clinical and respiratory parameters were recorded, and DSPC half-life and pool size and endogenous DSPC synthesis rate were calculated.

Results: Clinical characteristics and short-term outcomes did not differ between groups. In the 100 mg/kg group, 28 infants (70%) received a second dose after 25 +/- 11 hours and 9 (22.5%) a third dose after 41 +/- 11 hours; in the 200 mg/kg group, 6 infants (28.6%) received a second dose after 33 +/- 8 hours and 1 a third dose. The DSPC half-life was longer in the 200 mg/kg group (first dose: 32 +/- 19 vs 15 +/- 15 hours [P = .002]; second dose: 43 +/- 32 vs 21 +/- 13 hours [P = .025]). DSPC synthesis rates and pool sizes before the first and second doses did not differ between the groups. The 200 mg/kg group exhibited a greater reduction in the oxygenation index than did the 100 mg/kg group after the first (P = .009) and second (P = .018) doses.

Conclusions: Porcine surfactant given to preterm infants with RDS at a dose of 200 mg/kg resulted in a longer DSPC half-life, fewer retreatments, and better oxygenation index values.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biological Products / administration & dosage*
  • Biological Products / pharmacokinetics
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / drug therapy*
  • Infant, Premature, Diseases / physiopathology
  • Phosphatidylcholines / pharmacokinetics
  • Phospholipids / administration & dosage*
  • Phospholipids / pharmacokinetics
  • Pulmonary Gas Exchange* / drug effects
  • Pulmonary Surfactants / administration & dosage*
  • Pulmonary Surfactants / pharmacokinetics
  • Respiration, Artificial
  • Respiratory Distress Syndrome, Newborn / drug therapy*
  • Respiratory Distress Syndrome, Newborn / physiopathology
  • Trachea / metabolism

Substances

  • Biological Products
  • Phosphatidylcholines
  • Phospholipids
  • Pulmonary Surfactants
  • lecithins, disaturated
  • poractant alfa