Abstract
Because HMD is complicated by increased lung water and protein content, alveolar-capillary membrane permeability may be increased. Using aerosolized 99mtechnetium-diethylene triamine penta acetate (Tc-DTPA) as previously described (ARRD 127(4):299,1983), we assessed pulmonary epithelial permeability on 28 occasions in 13 intubated infants, 28 to 36 weeks gestation, with HMD. The lungs were insufflated with 10-15 μCi of Tc-DTPA and counts over the upper right chest recorded for 30 minutes with a Nal scintillation probe. Pulmonary half-life (T½) of Tc-DTPA was calculated from the slope of the clearance curve. Infants were studied as soon after intubation as possible and 2-3 times subsequently until extubation. In all 11 studies done within 72 hours of birth, the clearance curve was biphasic with a rapid phase T½ of 1.6 ± 0.2 min (mean ± SE). Normal adults have a monophasic curve with T½ of 45-80 minutes. In 7 of the 9 studies done just prior to extubation on infants who recovered (mean age 6 days), the curve had changed to monophasic with T½ of 48.1 ± 8.0 min. Two infants remained O2 and ventilator dependent and had persistent biphasic curves past 1 week of age with a rapid phase T½ of 1.4 ± 0.6 min. We conclude that pulmonary clearance of Tc-DTPA in infants with HMD in the first 3 days of life is rapid, suggesting increased permeability to small solutes, and as HMD resolves, permeability approaches normal adult values. Persistent lung disease is associated with persistent rapid clearance.
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Jefferies, A., Coates, G. & O'Brodovich, H. SEQUENTIAL CHANGES IN ALVEOLAR-CAPILLARY MEMBRANE PERMEABILITY IN HYALINE MEMBRANE DISEASE(HMD). Pediatr Res 18 (Suppl 4), 394 (1984). https://doi.org/10.1203/00006450-198404001-01807
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DOI: https://doi.org/10.1203/00006450-198404001-01807