We appreciate the comments by Fernandes and colleagues regarding our intrapartum surfactant pilot trial. We have posed many of the same questions to ourselves and are in agreement that several of their suggestions would be worth exploring.
First, they ask why we decided to use the standard intratracheal dose of Infasurf and wondered if we had considered delivering it with a radiologically visible marker, such as perfluorocarbon. Our rationale for using the standard dose was that this is what has been studied and approved for intratracheal administration (and thus might be more likely to be accepted by our IRB), the dose administered intratracheally theoretically should be far in excess of the necessary dose when calculated on the basis of mg/kg of surfactant phospholipids present in the lung, and we were reluctant to administer more fluid than necessary to the transitional airway. The perflurocarbon suggestion sounds quite interesting as the material would be radio-opaque and it has been used for delivering drugs to the airway. We have not had any personal experience with this compound and we understand that it has not been readily available from the manufacturer.
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