Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Changes in hemodynamics after rescue surfactant administration

Journal of Perinatology volume 33, pages 525–528 (2013)Cite this article

Subjects

Abstract

Objective:

To evaluate the hemodynamic changes occurring after rescue surfactant dosing in relation to the clinical respiratory response in preterm infants with respiratory distress syndrome.

Study Design:

We studied 20 infants who received surfactant (poractant alfa) after failing continuous positive airway pressure (CPAP) beyond 2 h of life. Consecutive echocardiograms were performed before the surfactant dose, 10 min after and 1 h after the surfactant dose. Superior vena cava flow, right ventricular output, atrial and patent ductus arteriosus diameter and direction of shunting were measured. A surfactant responder (SR) was defined as an infant whose inspired fraction of oxygen was reduced to air (0.21) by 3 h after surfactant administration. A surfactant non-responder (SNR) was defined as an infant who remained on more than 0.21 at 3 h postsurfactant administration. Concurrent physiological parameters (heart rate, transcutaneous CO2, mean arterial blood pressure, mean airway pressure) were also recorded. Subject characteristics were compared relative to noted hemodynamic effects.

Results:

Of the 20 infants enrolled in the study, 12 were SR. These infants received surfactant earlier and had increased measures of systemic blood flow after receipt of surfactant compared with baseline. SNR did not have changes in systemic blood flow from baseline after surfactant dosing. There was no change in ductal shunting or atrial shunting between the two groups.

Conclusions:

A good clinical response to rescue surfactant is seen in infants who received surfactant earlier and is associated with increase in systemic blood flow. Timing of rescue surfactant administration needs to be further evaluated in larger prospective studies.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Soll F . Prophylactic natural surfactant extract for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2000; CD000511.

  2. Finer NN, Carlo WA, Walsh MC, Rich W, Gantz MG, Laptook AR et al. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010; 362: 1970–1979.

    Article  CAS  Google Scholar 

  3. Sandri F, Plavka R, Simeoni U . CURPAP Advisory Board. The CURPAP study: an international randomized controlled trial to evaluate the efficacy of combining prophylactic surfactant and early nasal continuous positive airway pressure in very preterm infants. Neonatology 2008; 94 (1): 60–62.

    Article  Google Scholar 

  4. Dunn MS, Kaempf J, de Klerk A, de Klerk R, Reilly M, Howard D et al. Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates. Pediatrics 2011; 128: 1069–1076.

    Article  Google Scholar 

  5. Shangle CE, Haas RH, Vaida F, Rich WD, Finer NN . Effects of endotracheal intubation and surfactant on a 3-channel neonatal electroencephalogram. J Pediatr 2012; 161 (2): 252–257.

    Article  CAS  Google Scholar 

  6. McPherson C, Gal P, Ransom JL, Carlos RQ, Dimaguila MA, Smith M et al. Indomethacin pharmacodynamics are altered by surfactant: a possible challenge to current indomethacin dosing guidelines created before surfactant availability. Pediatr Cardiol 2010; 31 (4): 505–510.

    Article  Google Scholar 

  7. Raju TN, Langenberg P . Pulmonary hemorrhage and exogenous surfactant therapy: a metaanalysis. J Pediatr 1993; 123: 603–610.

    Article  CAS  Google Scholar 

  8. Saliba E, Nashashibi M, Vaillant MC, Nasr C, Laugier J . Instillation rate effects of Exosurf on cerebral and cardiovascular haemodynamics in preterm neonates. Arch Dis Child Fetal Neonatal Ed 1994; 71: F174–F178.

    Article  CAS  Google Scholar 

  9. Rabe H, Jorch G . Cerebral hemodynamics in perinatal pharmacology. Dev Pharmacol Ther 1991; 17: 128–132.

    Article  CAS  Google Scholar 

  10. Cowan F, Whitelaw A, Wertheim D, Silverman M . Cerebral blood flow velocity changes after rapid administration of surfactant. Arch Dis Child 1991; 66: 1105–1109.

    Article  CAS  Google Scholar 

  11. Roll C, Knief J, Horsch S, Hanssler L . Effect of surfactant administration on cerebral haemodynamics and oxygenation in premature infants—a near infrared spectroscopy study. Neuropediatrics 2000; 31: 16–23.

    Article  CAS  Google Scholar 

  12. Seppanen M, Kaapa P, Kero P . Acute effects of synthetic surfactant replacement on pulmonary blood flow in neonatal respiratory distress syndrome. Am J Perinatol 1994; 11: 382–385.

    Article  CAS  Google Scholar 

  13. Hamdan AH, Shaw NJ . Changes in pulmonary artery pressure in infants with respiratory distress syndrome following treatment with Exosurf. Arch Dis Child Fetal Neonatal Ed 1995; 72: F176–F179.

    Article  CAS  Google Scholar 

  14. Bloom MC, Roques-Gineste M, Fries F, Lelong-Tissier MC . Pulmonary haemodynamics after surfactant replacement in severe neonatal respiratory distress syndrome. Arch Dis Child Fetal Neonatal Ed 1995; 73: F95–F98.

    Article  CAS  Google Scholar 

  15. Chu J, Clements JA, Cotton EK, Klaus MH, Sweet AY, Tooley WH et al. Neonatal pulmonary ischemia. I. Clinical and physiological studies. Pediatrics 1967; 40: 709–782.

    Google Scholar 

  16. Sehgal A, Mak W, Dunn M, Kelly E, Whyte H, McCrindle B et al. Haemodynamic changes after delivery room surfactant administration to very low birth weight infants. Arch Dis Child Fetal Neonatal Ed 2010; 95 (5): F345–F351.

    Article  Google Scholar 

  17. Kluckow M, Evans N . Superior vena cava flow in newborn infants: a novel marker of systemic blood flow. Arch Dis Child Fetal Neonatal Ed 2000; 82: F182–F187.

    Article  CAS  Google Scholar 

  18. Hunt RW, Evans N, Rieger I, Kluckow M . Low superior vena cava flow and neurodevelopment at 3 years in very preterm infants. J Pediatr 2004; 145: 588–592.

    Article  Google Scholar 

  19. Kluckow M, Evans N . Low superior vena cava flow and intraventricular haemorrhage in preterm infants. Arch Dis Child Fetal Neonatal Ed 2000; 82 (3): F188–F194.

    Article  CAS  Google Scholar 

  20. Evans N, Kluckow M, Currie A . Range of echocardiographic findings in term neonates with high oxygen requirements. Arch Dis Child Fetal Neonatal Ed 1998; 78: F105–F111.

    Article  CAS  Google Scholar 

  21. Wiswell TE . Expanded uses of surfactant therapy. Clin Perinatol 2001; 3: 695–711.

    Article  Google Scholar 

  22. Kluckow M, Gill A, Jefferey M Evans N Ductal Echocardiographic Targeting and Early Closure Trial (DETECT): A Pilot Randomised Control Trial E-PAS;1675.5 2012.

  23. Evans N, Gournay V, Cabanas F, Kluckow M, Leone T, Groves A et al. Point-of-care ultrasound in the neonatal intensive care unit: international perspectives. Semin Fetal Neonatal Med 2011; 16 (1): 61–68.

    Article  Google Scholar 

Download references

Acknowledgements

The authors did not receive any financial support for the study.

Author information

Authors and Affiliations

  1. Division of Neonatology, UCSD Medical Center, San Diego, CA, USA

    A C Katheria & T A Leone

Authors
  1. A C Katheria
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T A Leone
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A C Katheria.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Katheria, A., Leone, T. Changes in hemodynamics after rescue surfactant administration. J Perinatol 33, 525–528 (2013). https://doi.org/10.1038/jp.2012.166

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2012.166

Keywords

This article is cited by

Search

Advanced search

Quick links