Am. J. Respir. Crit. Care Med., Vol 152, No. 3, 09 1995, 1050-1054.
Pharmacokinetics of bovine surfactant in neonatal respiratory distress syndrome
M Griese, P Dietrich and D Reinhardt
Kinderpoliklinik, Ludwig-Maximilians University, Munich, Germany.
Lung pharmacokinetics of lipid-extracted natural bovine surfactants of
different composition and currently used in neonatology were studied in 568
airway specimens from 23 consecutively admitted, small preterm neonates
(gestational age, 26.7 +/- 0.3 wk) who were mechanically ventilated for 5
to 7 d in a tertiary care center. In six infants who were mechanically
ventilated only, no changes in phospholipid quantity or composition were
noted. The other infants were randomly assigned to two groups that received
the natural surfactants Survanta or Alveofact, respectively. In the
Survanta group (n = 6), exponential decreases were observed in the
percentage of phosphatidylglycerol (PG) and sphingomyelin (Sph), while
phosphatidylinositol (PI) remained low. In Alveofact-treated neonates (n =
8), PG also decreased exponentially, whereas PI increased linearly during
the first week of life to values equivalent to those in infants not treated
with surfactant. The exponential disappearance of PG and Sph from
repetitive airway samples was utilized to calculate an apparent endogenous
pool size, for the time before surfactant treatment, of about 20 mg
phospholipids/kg body weight (n = 14). The apparent half-life of PG in the
Alveofact group (43 +/- 11 h) was shorter than in the Survanta-treated
infants (105 +/- 23 h, p < 0.01), and a similar value was obtained for
Sph (97 +/- 21 h, n = 6). There was no correlation between PG or Sph
half-life and the amount of surfactant applied. These data for human
neonates show a dependence of surfactant clearance and metabolism on the
type of bovine surfactant preparation administered.
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Copyright © 1995 American Thoracic Society
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