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Surfactant Protein Profile of Pulmonary Surfactant in Premature Infants

Neonatology, Department of Pediatrics, and Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Neonatology, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Children's Mercy Hospital, Kansas City, Missouri

Correspondence and requests for reprints should be addressed to Philip L. Ballard, M.D., Ph.D., Division of Neonatology, Room 416, Abramson Research Center, 3517 Civic Center Boulevard, Philadelphia, PA 19104. E-mail: ballardp{at}email.chop.edu

Although premature infants are known to be deficient in pulmonary surfactant, there is limited information regarding surfactant protein (SP) composition. To assess the postnatal profile of SPs, tracheal aspirate samples were collected from 35 intubated infants of 23–31 weeks of gestation between 8 and 80 days of age. In 71 large aggregate surfactant samples that had normal in vitro function (minimum surface tension of less than 1 mN/m by pulsating bubble surfactometry), mean ± SEM contents of SP-A, SP-B, and SP-C (3.7 kD) were 7.1 ± 1.4%, 1.8 ± 0.2%, and 4.6 ± 0.6%, respectively, of phospholipid. To assess SPs in the 1st week of life, we analyzed samples from additional infants receiving only synthetic replacement surfactant. On the 2nd day of life, contents of SP-A, SP-B, and SP-C were 13.4%, 8.4%, and 0.1%, respectively, of the mean levels for Day 8–80 samples. The major postnatal increases for SP-A, SP-B, and SP-C occurred during the 1st, 2nd, and 3rd weeks, respectively. We conclude that surfactant of newborn premature infants is markedly deficient in SPs, in particular SP-C. Despite continuing lung disease, some infants who are more than 1 week of age have surfactant with normal in vitro function that contains SPs at levels comparable to adult surfactant.

Key Words: surface tension • tracheal aspirate • bronchopulmonary dysplasia

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