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Late administration of surfactant replacement therapy increases surfactant protein-B content: a randomized pilot study.


ABSTRACT: Surfactant dysfunction may contribute to the development of bronchopulmonary dysplasia (BPD) in persistently ventilated preterm infants. We conducted a multicenter randomized, blinded, pilot study to assess the safety and efficacy of late administration of doses of a surfactant protein-B (SP-B)-containing surfactant (calfactant) in combination with prolonged inhaled nitric oxide (iNO) in infants ?1,000?g birth weight (BW).We randomized 85 preterm infants ventilated at 7-14 d after birth to receive either late administration of surfactant (up to 5 doses) plus prolonged iNO or iNO alone. Large aggregate surfactant was isolated from daily tracheal aspirates (TAs) for measurement of SP-B content, total protein, and phospholipid (PL).Late administration of surfactant had minimal acute adverse effects. Clinical status as well as surfactant recovery and SP-B content in tracheal aspirate were transiently improved as compared to the controls; these effects waned after 1 d. The change in SP-B content with surfactant dosing was positively correlated with SP-B levels during treatment (r = 0.50, P = 0.02).Low SP-B values increased with calfactant administration, but the relationship of this response to SP-B levels suggests that degradation is a contributing mechanism for SP-B deficiency and surfactant dysfunction. We conclude that late therapy with surfactant in combination with iNO is safe and transiently increases surfactant SP-B content, possibly leading to improved short- and long-term respiratory outcomes.

SUBMITTER: Keller RL 

PROVIDER: S-EPMC3548137 | biostudies-literature | 2012 Dec

REPOSITORIES: biostudies-literature

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Late administration of surfactant replacement therapy increases surfactant protein-B content: a randomized pilot study.

Keller Roberta L RL   Merrill Jeffrey D JD   Black Dennis M DM   Steinhorn Robin H RH   Eichenwald Eric C EC   Durand David J DJ   Ryan Rita M RM   Truog William E WE   Courtney Sherry E SE   Ballard Philip L PL   Ballard Roberta A RA  

Pediatric research 20121004 6


<h4>Background</h4>Surfactant dysfunction may contribute to the development of bronchopulmonary dysplasia (BPD) in persistently ventilated preterm infants. We conducted a multicenter randomized, blinded, pilot study to assess the safety and efficacy of late administration of doses of a surfactant protein-B (SP-B)-containing surfactant (calfactant) in combination with prolonged inhaled nitric oxide (iNO) in infants ≤1,000 g birth weight (BW).<h4>Methods</h4>We randomized 85 preterm infants ventil  ...[more]

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