Incomplete protection by prophylactic surfactant against the adverse effects of large lung inflations at birth in immature lambs

To investigate whether preceding surfactant instillation prevents the harmful effect of large lung inflations at birth in immature lambs, and, if not, to find out for how long the immature lung remains sensitive to large inflations. In an exploratory study, 12 preterm lambs given surfactant at birth were randomized to receive five large lung inflations at four different times: at birth just before or immediately after surfactant treatment; at 10 min; or at 60 min of age. In a confirmatory study, 10 pairs of preterm lamb twins were all given surfactant before the first breath. One lamb in each pair was randomised to receive large lung inflations immediately after surfactant while the other twin underwent similar inflations at 10-15 min of age. Animal laboratory. Anaesthetized lambs delivered by cesarean section at a gestational age of 127 days. Surfactant supplementation at birth. Five sustained lung inflations of 16 ml/kg at different times in relation to surfactant instillation. Pressure-limited mechanical ventilation for 4 h. The response to surfactant was assessed by ventilator settings, lung mechanics and lung histology. Preceding surfactant supplementation did not prevent the adverse effect of large lung inflations at birth on ventilatory efficiency and lung mechanics, but seemed to protect against severe lung injury. No adverse effect was seen from large lung inflations given at 10 min of age or later. Prophylactic surfactant supplementation does not fully protect against the harmful effect of large lung inflations during a short sensitive period immediately after birth.