Exogenous Natural Surfactant Research Articles

Early Immunomodulatory Effects of Different Natural Surfactant Preparations in Preterms With Respiratory Distress.

BackgroundRespiratory distress syndrome (RDS) is the most common respiratory disease in premature infants. Exogenous natural surfactant preparations are used in the treatment of RDS. In recent years, it has become increasingly evident that surfactant plays an immunoregulatory role.ObjectivesThe aim of this study was to evaluate cytokine and chemokine response following three different regimens of natural surfactant treatment in preterm newborns with RDS.MethodsPremature newborns below 32 weeks of gestation who were intubated for RDS and given early surfactant rescue therapy were included in the study. Newborns were randomly divided into three groups and Beractant 100 mg/kg (B-100), Poractant alfa 100 mg/kg (Pα-100) and Poractant alfa 200 mg/kg (Pα-200) were administered intratracheally. Blood samples and transtracheal aspirates (TA) were collected just before and 4–6 h after the surfactant treatment. Total eosinophil count, inducible T Cell alpha chemoattractant (ITaC), macrophage inflammatory protein 3 beta (MIP3b), interleukins (IL) 5, 8, 9, 10, 13, immunoglobulin E (IgE), interferon gamma (IFN-γ), eotaxin and tumor necrosis factor beta-1 (TGF-β1) were measured from blood and tracheal aspirate samples.ResultsA total of 45 infants, 15 in each group, were included in the study. Mean gestational age, birth weight, antenatal, demographic and clinical characteristics of the study groups were similar. IFNγ concentration and eosinophil counts in TA decreased after surfactant replacement in all groups, especially in the infants treated with Pα-100 and Pα-200. Eotaxin, TGF beta and IL-8 concentrations in TA increased significantly in the infants treated with Pα-100 and Pα-200. IL-9 levels in TA decreased in the B-100 group but increased in the Pα-100 and Pα-200 groups. Blood levels of cytokines and chemokines showed significantly decreased levels of ITaC and MIP3b only in the B-100 group, but no significant change was observed in the Pα-100 and Pα-200 groups.ConclusionIn our study, the different immunomodulatory effects of natural surfactant preparations on newborn lung is proven. We found that Poractant α, one of the natural surfactant preparations, shifted the lung immune system toward TH2.

Surfactant therapy for COVID-19 related ARDS: a retrospective case\u2013control pilot study

BackgroundCOVID-19 causes acute respiratory distress syndrome (ARDS) and depletes the lungs of surfactant, leading to prolonged mechanical ventilation and death. The feasibility and safety of surfactant delivery in COVID-19 ARDS patients have not been established.MethodsWe performed retrospective analyses of data from patients receiving off-label use of exogenous natural surfactant during the COVID-19 pandemic. Seven COVID-19 PCR positive ARDS patients received liquid Curosurf (720 mg) in 150 ml normal saline, divided into five 30 ml aliquots) and delivered via a bronchoscope into second-generation bronchi. Patients were matched with 14 comparable subjects receiving supportive care for ARDS during the same time period. Feasibility and safety were examined as well as the duration of mechanical ventilation and mortality.ResultsPatients showed no evidence of acute decompensation following surfactant installation into minor bronchi. Cox regression showed a reduction of 28-days mortality within the surfactant group, though not significant. The surfactant did not increase the duration of ventilation, and health care providers did not convert to COVID-19 positive.ConclusionsSurfactant delivery through bronchoscopy at a dose of 720 mg in 150 ml normal saline is feasible and safe for COVID-19 ARDS patients and health care providers during the pandemic. Surfactant administration did not cause acute decompensation, may reduce mortality and mechanical ventilation duration in COVID-19 ARDS patients. This study supports the future performance of randomized clinical trials evaluating the efficacy of meticulous sub-bronchial lavage with surfactant as treatment for patients with COVID-19 ARDS.

Audit on the Application of Surfactant in Premature Babies in Assiut University Children Hospital

Abstract Background: To evaluate the use of exogenous natural surfactant for Respiratory Distress Syndrome (RDS) in pre-mature babies, identify areas where European Consensus Guidelines on the Management 2013 Update, modified by The Egyptian Consensus on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants 2014 are applied to as a reference standard in Assiut University Children Hospital and identify those points to be targeted for improve-ment.Patients and Methods: A retrospective audit was under-taken over a 12-month period between 1st of January, 2016 to the 31st of December 2016. It included all babies less than 37 weeks gestation with respiratory distress syndrome who received surfactant as a rescue treatment, guided by European Consensus Guidelines on the Management 2013 Update, modified by The Egyptian Consensus on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants 2014 and admitted to Neonatal Intensive Care Unit of Assiut University Children Hospital during this period. Results: All cases with severe respiratory distress that needed surfactant injection and admitted in Assiut university children hospital from 1st of January to 3 1th of December 2016 were included in the study. The study included 50 patients with severe respiratory distress syndrome.Conclusion: Surfactant replacement therapy has been available for about 37 years, revolutionizing neonatal respi-ratory care after its introduction in the 1980s. Along with antenatal steroids, surfactants improve survival for preterm babies and they are now recommended routinely as early in the course of Respiratory Distress Syndrome (RDS) as possible. The present study aimed to evaluate the use of surfactant for Respiratory Distress Syndrome (RDS) in premature babies admitted at NICU of Assiut university children hospital during the period from 1st of January to 31st of December 2016 using European Consensus Guidelines on the Management 2013 Update, modified by The Egyptian Consensus on the Manage-ment of Neonatal Respiratory Distress Syndrome in Preterm Infants 2014.The study included 50 cases with respiratory distress syndrome who received surfactant therapy.Data of the study showed that treatment regimens for cases of RDS in Assiut University Children Hospital partially followed the reference standard of the study concerning application of surfactant in premature babies.•Data of the gestational age and weight and sex were recorded in 100% of cases.•Data concerning clinical evaluation of the studied group were recorded in 100% cases.•Data concerning obstetric history and prenatal care were fulfilled well but there were no records concerning receiving a course of antibiotics if there is preterm, pre-labor rupture of membranes nor short term tocolytic drugs. Also, the data showed that only 28% of mothers received a course of prenatal steroids if preterm labor was expected.•Data concerning delivery room stabilization were fulfilled well but there were no records concerning delayed cord clamping and there was no available CPAP at the delivery room nor plastic bag for stabilization of preterm baby with respiratory distress syndrome.•Data concerning surfactant therapy were fulfilled well but there was no data that any case received prophylactic surfactant therapy neither with nor without INSURE tech-nique.•Data concerning respiratory support were fulfilled well but no cases received CPAP as a 1st line respiratory support for any spontaneously breathing preterm with RDS at delivery room and no cases received CPAP with early rescue surfactant which is now considered the optimal management for babies with RDS.•Data concerning supportive care were fulfilled in 100% of cases but no cases received enteral feeding from the 1st day which is strongly recommended with careful fluid balance for early aggressive nutritional support.•Data concerning prognosis showed that the vast majority of dead cases were below 32 weeks and below 1KG.

Exogenous Natural Surfactant for Treatment of Acute Lung Injury and the Acute Respiratory Distress Syndrome

Exogenous Natural Surfactant for Treatment of Acute Lung Injury and the Acute Respiratory Distress Syndrome

Exogenous Natural Surfactant for Treatment of Acute Lung Injury and the Acute Respiratory Distress Syndrome

Compositional changes in surfactant and/or decreased surfactant content of the lungs are common features in patients with acute respiratory failure. Instillation of exogenous surfactant into the lungs of neonates with respiratory distress syndrome or pediatric patients with acute respiratory distress syndrome (ARDS) has resulted in improved survival. We conducted this trial to determine whether the instillation of exogenous surfactant would improve the Day 28 outcome of adult patients with acute lung injury (ALI) or ARDS. A total of 418 patients with ALI and ARDS were included in an international, multicenter, stratified, randomized, controlled, open, parallel-group study. We randomly assigned 418 patients to receive usual care either with or without instillation of exogenous natural porcine surfactant HL 10 as large boluses. The primary endpoint was death rate before or on Day 28. Secondary endpoints were adverse event and death rate on day 180. The 28-day death rate in the usual care group was 24.5% compared with 28.8% in the HL 10 group. The estimated odds ratio for death at Day 28 in the usual care group versus the HL 10 group was 0.75 (95% CI, 0.48-1.18; P = 0.22). The most common adverse events related to HL 10 administration were temporary hypoxemia defined as oxygen saturation less than 88% (51.9% in HL 10 group vs. 25.2% in usual care) and hypotension defined as mean arterial blood pressure less than 60 mm Hg (34.1% in HL 10 group vs. 17.1% in usual care). In this study, instillation of a large bolus of exogenous natural porcine surfactant HL 10 into patients with acute lung injury and ARDS did not improve outcome and showed a trend toward increased mortality and adverse effects. Clinical trial registered with www.clinicaltrials.gov (NCT 00742482).

Déficits secondaires en surfactant chez le grand prématuré

Primary deficiency of surfactant is responsible for the respiratory distress syndrome and concerns premature neonates born before 33 weeks of gestation. However, newborns may develop respiratory disorders related to a secondary deficiency or dysfunction of surfactant. We report the course of three extremely low birth weight premature infants who experienced clinical respiratory decompensation at two weeks and showed a marked improvement after exogenous natural surfactant administration.

99mTc-ENS ventilation scintigraphy: preliminary study in human volunteers

Exogenous natural surfactant (ENS) labeled with 99mTc ( 99mTc-ENS, 900–1110 MBq), a new radiopharmaceutical for ventilation scintigraphy, was nebulized during 3 min to five volunteers. For comparative purposes, 99mTc-diethylenetriamine pentaacetic acid (DTPA) was studied in the same way. 99mTc-ENS images were of at least the same quality as 99mTc-DTPA images. However, in smoking volunteers, the 99mTc-DTPA images show some areas that seemed to be not well-ventilated, although these areas appeared well-ventilated when the study was performed with 99mTc-ENS. These results suggest that 99mTc-ENS can be used for ventilation scintigraphy to allow the observation of some areas that cannot been visualized using 99mTc-DTPA as ventilation agent.

99mTc-ENS, a New Radiopharmaceutical for Aerial Lung Scintigraphy: Comparative Studies in Rats

The biological behavior of 99mTc-labeled exogenous natural surfactant ( 99mTc-ENS) was studied and compared to 99mTc-diethylenetriaminepentaacetate ( 99mTc-DTPA) and 99mTcO 4 −. The labeling yield percentages for 99mTc-DTPA and 99mTc-ENS were higher than 95%. Biodistribution studies performed after aerosolization showed that the percentage of activity concentration in lungs for 99mTc-ENS was 98.7 ± 1.3%, for 99mTc-DTPA 77.8 ± 20.6%, and 22.4 ± 7.5% in the case of 99mTcO 4 −. These results suggest that this new radiopharmaceutical shows an optimal lung concentration, and therefore it can be considered for clinical trials.

Clinical experience with exogenous natural surfactant.

More than 600 preterm babies have been enrolled in randomised controlled trials of natural surfactant replacement to prevent or treat the respiratory distress syndrome. Four types of natural surfactant, prepared from animal lungs or human amniotic fluid, have been used. Each contains mainly phospholipids and small amounts (1-5%) of apoproteins. Two types of trial have been used to test these natural surfactants. In prophylaxis studies, babies less than 30 weeks of gestation are given surfactant intratracheally at birth. These studies show a reduction in mortality and pneumothorax and an increase in survival without bronchopulmonary dysplasia (BPD) in treated babies compared to matched controls. In rescue studies, where ill babies are given surfactant about 5 h after birth, there is a reduction in mortality, pneumothorax, intraventricular haemorrhage and BPD, and an increase in survival without BPD. However, treated babies also show an increased incidence of patent ductus arteriosus which has been the only side effect noted to date. All these surfactant preparations show similar effects and studies comparing the different types are unlikely to be undertaken as large numbers of babies would need to be enrolled to show differences. Many uncertainties remain, however, and include the dose of surfactant needed, whether repeat dosing is better than single dosing, whether treatment of less-ill babies is justified, and the results of long-term follow-up studies.