Treatment with exogenous surfactant stimulates endogenous surfactant synthesis in premature infants with respiratory distress syndrome
OBJECTIVETreatment of preterm infants with respiratory distress syndrome (RDS) with exogenous surfactant has greatly improved clinical outcome. Some infants require multiple doses, and it has not been studied whether these large amounts of exogenous surfactant disturb endogenous surfactant metabolis...
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Veröffentlicht in: | Critical care medicine 2000-10, Vol.28 (10), p.3383-3388 |
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creator | Bunt, Jan Erik H Carnielli, Virgilio P Janssen, Daphne J Wattimena, J L. Darcos Hop, Wim C Sauer, Pieter J Zimmermann, Luc J. I |
description | OBJECTIVETreatment of preterm infants with respiratory distress syndrome (RDS) with exogenous surfactant has greatly improved clinical outcome. Some infants require multiple doses, and it has not been studied whether these large amounts of exogenous surfactant disturb endogenous surfactant metabolism in humans. We studied endogenous surfactant metabolism in relation to different amounts of exogenous surfactant, administered as rescue therapy for RDS.
DESIGNProspective clinical study.
SETTINGNeonatal intensive care unit in a university hospital.
PATIENTSA total of 27 preterm infants intubated and mechanically ventilated for respiratory insufficiency.
INTERVENTIONSInfants received a 24-hr infusion with the stable isotope [U-C]glucose starting 5.3 ± 0.5 hrs after birth. The C-incorporation into palmitic acid in surfactant phosphatidylcholine (PC) isolated from serial tracheal aspirates was measured. Infants received either zero (n = 5), one (n = 4), two (n = 15), or three (n = 3) doses of Survanta (100 mg/kg) when clinically indicated.
MEASUREMENTS AND MAIN RESULTSUsing multiple regression analysis, the absolute synthesis rate (ASR) of surfactant PC from plasma glucose increased with 1.3 ± 0.4 mg/kg/day per dose of Survanta (p = .007) (mean ± sem). The ASR of surfactant PC from glucose was increased by prenatal corticosteroid treatment with 1.3 ± 0.4 mg/kg/day per dose corticosteroid (p = .004), and by the presence of a patent ductus arteriosus with 2.1 ± 0.7 mg/kg/day (p = .01).
CONCLUSIONThese data are reassuring and show for the first time in preterm infants that multiple doses of exogenous surfactant for RDS are tolerated well by the developing lung and stimulate endogenous surfactant synthesis. |
doi_str_mv | 10.1097/00003246-200010000-00001 |
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DESIGNProspective clinical study.
SETTINGNeonatal intensive care unit in a university hospital.
PATIENTSA total of 27 preterm infants intubated and mechanically ventilated for respiratory insufficiency.
INTERVENTIONSInfants received a 24-hr infusion with the stable isotope [U-C]glucose starting 5.3 ± 0.5 hrs after birth. The C-incorporation into palmitic acid in surfactant phosphatidylcholine (PC) isolated from serial tracheal aspirates was measured. Infants received either zero (n = 5), one (n = 4), two (n = 15), or three (n = 3) doses of Survanta (100 mg/kg) when clinically indicated.
MEASUREMENTS AND MAIN RESULTSUsing multiple regression analysis, the absolute synthesis rate (ASR) of surfactant PC from plasma glucose increased with 1.3 ± 0.4 mg/kg/day per dose of Survanta (p = .007) (mean ± sem). The ASR of surfactant PC from glucose was increased by prenatal corticosteroid treatment with 1.3 ± 0.4 mg/kg/day per dose corticosteroid (p = .004), and by the presence of a patent ductus arteriosus with 2.1 ± 0.7 mg/kg/day (p = .01).
CONCLUSIONThese data are reassuring and show for the first time in preterm infants that multiple doses of exogenous surfactant for RDS are tolerated well by the developing lung and stimulate endogenous surfactant synthesis.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/00003246-200010000-00001</identifier><identifier>PMID: 11057790</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anti-Inflammatory Agents - therapeutic use ; Biological and medical sciences ; Biological Products ; Blood Glucose - analysis ; Carbon Radioisotopes - administration & dosage ; Carbon Radioisotopes - metabolism ; Dexamethasone - therapeutic use ; Drug Therapy, Combination ; Ductus Arteriosus, Patent - complications ; Emergency and intensive care: neonates and children. Prematurity. Sudden death ; Gestational Age ; Humans ; Infant, Newborn ; Infusions, Intravenous ; Intensive care medicine ; Medical sciences ; Prospective Studies ; Pulmonary Surfactants - biosynthesis ; Pulmonary Surfactants - blood ; Pulmonary Surfactants - therapeutic use ; Regression Analysis ; Respiratory Distress Syndrome, Newborn - complications ; Respiratory Distress Syndrome, Newborn - drug therapy ; Respiratory Distress Syndrome, Newborn - metabolism ; Time Factors ; Treatment Outcome</subject><ispartof>Critical care medicine, 2000-10, Vol.28 (10), p.3383-3388</ispartof><rights>2000 Lippincott Williams & Wilkins, Inc.</rights><rights>2000 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3851-ab48f8942a221ae254dc3dec92734674685c2febea7b956cbbc030a0b75dbffe3</citedby><cites>FETCH-LOGICAL-c3851-ab48f8942a221ae254dc3dec92734674685c2febea7b956cbbc030a0b75dbffe3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1534047$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11057790$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bunt, Jan Erik H</creatorcontrib><creatorcontrib>Carnielli, Virgilio P</creatorcontrib><creatorcontrib>Janssen, Daphne J</creatorcontrib><creatorcontrib>Wattimena, J L. Darcos</creatorcontrib><creatorcontrib>Hop, Wim C</creatorcontrib><creatorcontrib>Sauer, Pieter J</creatorcontrib><creatorcontrib>Zimmermann, Luc J. I</creatorcontrib><title>Treatment with exogenous surfactant stimulates endogenous surfactant synthesis in premature infants with respiratory distress syndrome</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVETreatment of preterm infants with respiratory distress syndrome (RDS) with exogenous surfactant has greatly improved clinical outcome. Some infants require multiple doses, and it has not been studied whether these large amounts of exogenous surfactant disturb endogenous surfactant metabolism in humans. We studied endogenous surfactant metabolism in relation to different amounts of exogenous surfactant, administered as rescue therapy for RDS.
DESIGNProspective clinical study.
SETTINGNeonatal intensive care unit in a university hospital.
PATIENTSA total of 27 preterm infants intubated and mechanically ventilated for respiratory insufficiency.
INTERVENTIONSInfants received a 24-hr infusion with the stable isotope [U-C]glucose starting 5.3 ± 0.5 hrs after birth. The C-incorporation into palmitic acid in surfactant phosphatidylcholine (PC) isolated from serial tracheal aspirates was measured. Infants received either zero (n = 5), one (n = 4), two (n = 15), or three (n = 3) doses of Survanta (100 mg/kg) when clinically indicated.
MEASUREMENTS AND MAIN RESULTSUsing multiple regression analysis, the absolute synthesis rate (ASR) of surfactant PC from plasma glucose increased with 1.3 ± 0.4 mg/kg/day per dose of Survanta (p = .007) (mean ± sem). The ASR of surfactant PC from glucose was increased by prenatal corticosteroid treatment with 1.3 ± 0.4 mg/kg/day per dose corticosteroid (p = .004), and by the presence of a patent ductus arteriosus with 2.1 ± 0.7 mg/kg/day (p = .01).
CONCLUSIONThese data are reassuring and show for the first time in preterm infants that multiple doses of exogenous surfactant for RDS are tolerated well by the developing lung and stimulate endogenous surfactant synthesis.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anti-Inflammatory Agents - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Biological Products</subject><subject>Blood Glucose - analysis</subject><subject>Carbon Radioisotopes - administration & dosage</subject><subject>Carbon Radioisotopes - metabolism</subject><subject>Dexamethasone - therapeutic use</subject><subject>Drug Therapy, Combination</subject><subject>Ductus Arteriosus, Patent - complications</subject><subject>Emergency and intensive care: neonates and children. Prematurity. Sudden death</subject><subject>Gestational Age</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Infusions, Intravenous</subject><subject>Intensive care medicine</subject><subject>Medical sciences</subject><subject>Prospective Studies</subject><subject>Pulmonary Surfactants - biosynthesis</subject><subject>Pulmonary Surfactants - blood</subject><subject>Pulmonary Surfactants - therapeutic use</subject><subject>Regression Analysis</subject><subject>Respiratory Distress Syndrome, Newborn - complications</subject><subject>Respiratory Distress Syndrome, Newborn - drug therapy</subject><subject>Respiratory Distress Syndrome, Newborn - metabolism</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kstuFDEQRS1ERIaEX0C9QOwa_Gx3L1HES4rEJllb1e5yxtCPweXWMD_Ad-NhBrIBL-y6rlNl2deMVYK_Ebyzb3kZSuqmliUQR1UfJ_GEbYRRRchOPWUbzjteK92pS_ac6GsBtLHqGbsUghtrO75hP-8SQp5wztU-5m2FP5YHnJeVKlpTAJ-hZCjHaR0hI1U4D_8CDnPeIkWq4lztEk6Q14RFhJKlU-eEtIsJ8pIO1RApF03HwiEtE16ziwAj4YvzesXuP7y_u_lU3375-Pnm3W3tVWtEDb1uQ9tpCVIKQGn04NWAvpNW6cbqpjVeBuwRbN-Zxve954oD760Z-hBQXbHXp767tHxfkbKbInkcR5ix3MlZqRrZNryA7Qn0aSFKGNwuxQnSwQnujh64Px64vx783hKl9OX5jLWfcHgsPD96AV6dASAPY0gw-0iPnFGaa1swfcL2y5gx0bdx3WNyW4Qxb93_voD6BSbzo1g</recordid><startdate>200010</startdate><enddate>200010</enddate><creator>Bunt, Jan Erik H</creator><creator>Carnielli, Virgilio P</creator><creator>Janssen, Daphne J</creator><creator>Wattimena, J L. Darcos</creator><creator>Hop, Wim C</creator><creator>Sauer, Pieter J</creator><creator>Zimmermann, Luc J. I</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200010</creationdate><title>Treatment with exogenous surfactant stimulates endogenous surfactant synthesis in premature infants with respiratory distress syndrome</title><author>Bunt, Jan Erik H ; Carnielli, Virgilio P ; Janssen, Daphne J ; Wattimena, J L. Darcos ; Hop, Wim C ; Sauer, Pieter J ; Zimmermann, Luc J. I</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3851-ab48f8942a221ae254dc3dec92734674685c2febea7b956cbbc030a0b75dbffe3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anti-Inflammatory Agents - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Biological Products</topic><topic>Blood Glucose - analysis</topic><topic>Carbon Radioisotopes - administration & dosage</topic><topic>Carbon Radioisotopes - metabolism</topic><topic>Dexamethasone - therapeutic use</topic><topic>Drug Therapy, Combination</topic><topic>Ductus Arteriosus, Patent - complications</topic><topic>Emergency and intensive care: neonates and children. Prematurity. Sudden death</topic><topic>Gestational Age</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Infusions, Intravenous</topic><topic>Intensive care medicine</topic><topic>Medical sciences</topic><topic>Prospective Studies</topic><topic>Pulmonary Surfactants - biosynthesis</topic><topic>Pulmonary Surfactants - blood</topic><topic>Pulmonary Surfactants - therapeutic use</topic><topic>Regression Analysis</topic><topic>Respiratory Distress Syndrome, Newborn - complications</topic><topic>Respiratory Distress Syndrome, Newborn - drug therapy</topic><topic>Respiratory Distress Syndrome, Newborn - metabolism</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bunt, Jan Erik H</creatorcontrib><creatorcontrib>Carnielli, Virgilio P</creatorcontrib><creatorcontrib>Janssen, Daphne J</creatorcontrib><creatorcontrib>Wattimena, J L. Darcos</creatorcontrib><creatorcontrib>Hop, Wim C</creatorcontrib><creatorcontrib>Sauer, Pieter J</creatorcontrib><creatorcontrib>Zimmermann, Luc J. I</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bunt, Jan Erik H</au><au>Carnielli, Virgilio P</au><au>Janssen, Daphne J</au><au>Wattimena, J L. Darcos</au><au>Hop, Wim C</au><au>Sauer, Pieter J</au><au>Zimmermann, Luc J. I</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment with exogenous surfactant stimulates endogenous surfactant synthesis in premature infants with respiratory distress syndrome</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2000-10</date><risdate>2000</risdate><volume>28</volume><issue>10</issue><spage>3383</spage><epage>3388</epage><pages>3383-3388</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVETreatment of preterm infants with respiratory distress syndrome (RDS) with exogenous surfactant has greatly improved clinical outcome. Some infants require multiple doses, and it has not been studied whether these large amounts of exogenous surfactant disturb endogenous surfactant metabolism in humans. We studied endogenous surfactant metabolism in relation to different amounts of exogenous surfactant, administered as rescue therapy for RDS.
DESIGNProspective clinical study.
SETTINGNeonatal intensive care unit in a university hospital.
PATIENTSA total of 27 preterm infants intubated and mechanically ventilated for respiratory insufficiency.
INTERVENTIONSInfants received a 24-hr infusion with the stable isotope [U-C]glucose starting 5.3 ± 0.5 hrs after birth. The C-incorporation into palmitic acid in surfactant phosphatidylcholine (PC) isolated from serial tracheal aspirates was measured. Infants received either zero (n = 5), one (n = 4), two (n = 15), or three (n = 3) doses of Survanta (100 mg/kg) when clinically indicated.
MEASUREMENTS AND MAIN RESULTSUsing multiple regression analysis, the absolute synthesis rate (ASR) of surfactant PC from plasma glucose increased with 1.3 ± 0.4 mg/kg/day per dose of Survanta (p = .007) (mean ± sem). The ASR of surfactant PC from glucose was increased by prenatal corticosteroid treatment with 1.3 ± 0.4 mg/kg/day per dose corticosteroid (p = .004), and by the presence of a patent ductus arteriosus with 2.1 ± 0.7 mg/kg/day (p = .01).
CONCLUSIONThese data are reassuring and show for the first time in preterm infants that multiple doses of exogenous surfactant for RDS are tolerated well by the developing lung and stimulate endogenous surfactant synthesis.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>11057790</pmid><doi>10.1097/00003246-200010000-00001</doi><tpages>6</tpages></addata></record> |
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subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anti-Inflammatory Agents - therapeutic use Biological and medical sciences Biological Products Blood Glucose - analysis Carbon Radioisotopes - administration & dosage Carbon Radioisotopes - metabolism Dexamethasone - therapeutic use Drug Therapy, Combination Ductus Arteriosus, Patent - complications Emergency and intensive care: neonates and children. Prematurity. Sudden death Gestational Age Humans Infant, Newborn Infusions, Intravenous Intensive care medicine Medical sciences Prospective Studies Pulmonary Surfactants - biosynthesis Pulmonary Surfactants - blood Pulmonary Surfactants - therapeutic use Regression Analysis Respiratory Distress Syndrome, Newborn - complications Respiratory Distress Syndrome, Newborn - drug therapy Respiratory Distress Syndrome, Newborn - metabolism Time Factors Treatment Outcome |
title | Treatment with exogenous surfactant stimulates endogenous surfactant synthesis in premature infants with respiratory distress syndrome |
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