Abstract
The lecithin/sphingomyelin (L/S) ratio & percent phosphatidyl glycerol (PG) in amniotic fluid are used to evaluate fetal lung maturity, but their value in tracheal aspirates to predict respiratory distress syndrome (RDS) has not been defined. Phospholipid lung profiles on tracheal aspirates within 12 hrs of birth from 551 babies were analyzed by 2-dimensional thin layer chromatography & reflectance densitometry. Infants with respiration, asphyxia, pneumonia, syndromes, chorioamionitis, IUGR, or pulmonary hypoplasia were excluded. Radiologic & clinical criteria were used to classify the remaining patients as RDS (125), retained lung fluid (RLF) (50), or no respiratory disease (60). L/S best predicted RDS (78%) when values were ≤2.6 & identified normals (85%) above 2.6. The mean L/S for RLF (4.06) & normals (4.37) were higher than for RDS (2.3). Accuracy of PG in predicting RDS was best (96%) at trace (<1%) or less, identifying 83% of normals. Seventeen percent of normals & 56% of RLF had <1% PG, while 4% of RDS cases had ≥1% PG. Lung profile values accepted for amniotic fluid seem to overestimate pulmonary maturity when applied to tracheal aspirates. Tracheal aspirate L/S & PG together are highly useful in the biochemical diagnosis of RDS.
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