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Am. J. Respir. Crit. Care Med., Volume 161, Number 5, May 2000, 1584-1589

Exogenous Surfactant Kinetics in Infant Respiratory Distress Syndrome: A Novel Method with Stable Isotopes

MIRKA TORRESIN, LUC J. I. ZIMMERMANN, PAOLA E. COGO, PAOLA CAVICCHIOLI, TAMARA BADON, GIUSEPPE GIORDANO, FRANCO ZACCHELLO, PIETER J. J. SAUER, and VIRGILIO P. CARNIELLI

Department of Pediatrics, University of Padua, Padua, Italy; Division of Neonatology, Sophia Children's Hospital, Erasmus University, Rotterdam, The Netherlands; and Beatrix Children's Hospital, Groningen, The Netherlands

Little is known about surfactant metabolism in newborn infants, since radioactive isotopes cannot be used in humans. We describe here a new method for studying exogenous surfactant pharmacokinetics in vivo. We measured surfactant half-life, pool size, and turnover time in eight preterm infants (gestational age: 30 ± 2 wk; birth weight: 1,416 ± 202 g) who were mechanically ventilated because of infant respiratory distress syndrome. We administered two doses of 100 mg/kg each of a natural porcine surfactant with 13C-labeled dipalmitoylphosphatidylcholine as a tracer. The 13C enrichment of surfactant disaturated phosphatidylcholine (DSPC) was measured in serial tracheal aspirates by gas chromatography-mass spectrometry. The DSPC half-life was 34.2 ± 9.4 h (mean ± SD; range: 21.8 to 45.9 h). The apparent DSPC pool sizes were 5.8 ± 6.1 mg/kg (range: 0.1 to 17.0 mg/kg) and 17.3 ± 13.6 mg/kg (range: 3.3 to 41.0 mg/kg) at the time of the first and second surfactant doses, respectively. We present a novel and safe method that allows the tracing of exogenous surfactant phosphatidylcholine, the major lipid component of pulmonary surfactant, in infants who receive exogenous surfactant. This method could be a valuable tool for studying: (1) therapies that enhance lung/surfactant maturation; (2) the dosing and timing of surfactant therapy in different lung diseases; and (3) the comparison of different surfactant preparations.




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