Intraamniotic Infused Surfactant is Aspirated by the Fetus and Improves Lung Biochemical Parameters in an Animal Model of Congenital Diaphragmatic Hernia(CDH) 1756

Abstract

We investigated if the intraamniotc admnistration of surfactant could improve the hypoplastic lungs of animals with CDH. Left-sided diaphragmatic hernias were created surgically in 17 fetal rabbits on gestational day 24(term= 31 days). Group 1 (three CDH fetuses): a mixture of 40 mg of Curosurf with a suspension of micro particles of coal was infused into the amniotic cavity, to verify if the stressed fetus may aspirate in utero. Group 2: six CDH fetuses. Group 3: eight CDH fetuses: 40 mg of Curosurf was infused into the amniotic cavity. The fetuses were delivered on gestational day 30 (35 non-operated fetuses served as controls). The left lungs were submitted to morphometric analysis (lung weight / body weight), glycogen determination(lung glycogen levels normally decrease near term, so that a decreased glycogen level is an indication of pulmonary maturation), morphometric evaluation of elastic fiber system of pulmonary parenchyma and colorimetric analysis of collagen content. The presence of micro-particles of coal into the alveoli of fetal lungs in the first group was a clear evidence that the stressed fetus may aspirate intraamniotic content. Results are expressed as mean±SD. The decreased weight of the lungs associated with CDH were not reversed by the administration of surfactant. CDH resulted in increased lung content of collagen and glycogen, and decreased lung linear density of elastic fiber. Intraamniotic surfactant administration could partially reverse these changes, and then this therapy may be indicated for fetuses with CDH. (Table).