The overall risk of BPD in premature neonates with RDS is not decreased with natural exogenous surfactant (NES) treatment. In vitro studies have shown anti-inflammatory properties of NES whereas in vivo data are controversial. The present study tests the hypothesis that treatment with NES with a modified porcine NES (Curosurf) stimulates the acute phase reaction in non-infected premature neonates with respiratory distress syndrome (RDS). Sixty consecutive premature infants [GA 30(25-34)wks; BW 1350(720-2480)g] treated with Curosurf 200 mg/kg were studied. NES-treated infants without proven infection in Group I were compared with NES-treated infected infants in Group II. These two surfactant-treated groups were compared with Group III, a retrospective control group of infants with RDS treated with mechanical ventilation alone without NES. The baseline characteristics of the patients in the three groups were similar for GA and BW. Concentrations of C-reactive protein (CRP) were compared in the 3 groups before (day 0). and 1 to 4 days after surfactant administration. Comparisons between groups were analyzed with the Mann-Whitney t-test, and within groups by the Wilcoxon rank test. The data show that concentrations of CRP increase following porcine NES treatment in non-infected premature infants with RDS, indicating stimulation of an acute phase reaction. We conclude that the increase in [CRP] may not be a reliable indicator of neonatal sepsis in porcine NES-treated infants. Further studies are needed to precisely define the mechanisms involved and impact on pulmonary outcome.Table

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