Surfactant administration for neonatal respiratory distress does not improve lung interstitial fluid clearance: echographic and experimental evidence

Abstract

Recent ultrasonographic studies suggest that the administration of surfactant to preterm infants with respiratory distress syndrome (RDS) does not affect lung water clearance. The purpose of the study was also to look at clearance of lung water in preterm rabbits receiving surfactant. Lung ultrasound was performed in 73 neonates at different gestational ages (range 23-34 weeks) with radiological and clinical signs of RDS, before and after surfactant administration. In premature rabbits (28-29 days' gestational age), either receiving or not receiving surfactant, we followed the time course of lung water balance considering the wet weight/dry weight ratio, the morphology and compliance of alveoli and pulmonary interstitial pressure. In all RDS infants lung ultrasound images consistently showed a generalized increase in extravascular lung fluid which remained unchanged after surfactant administration and did not affect the rate of fluid clearance. Surfactant administration in premature rabbits did not improve the time course of lung fluid clearance. Data from ultrasound in preterm babies are confirmed by animal experiments.