Abstract
Ten very low birth weight infants (770 - 1400g) with severe RDS were treated with porcine surfactant (Curosurf) at a median age of 6.7 h. The typical response was immediate improvement of oxygenation. 4 babies could be weaned from the ventilator within 36 h. However, in three patients (birth weights 1300g, 890g, 830g) improvement was only transient; these infants died from pulmonary insufficiency at the age of 9, 9, and 14 days, respectively, in spite of repeated instillation of surfactant within 21 - 64 h after the first treatment.
Histological examination of lung specimens obtained at autopsy revealed, in one case, broadened alveolar septae with interstitial infiltration of lymphocytes and monocytes (representing organizing hyaline membrane disease?); in the two other cases, there was evidence of obliterative bronchiolitis compatible with an early stage of bronchopulmonary dysplasia. In all three cases, Sudan-stained frozen sections showed lipid deposits in macrophages. Such lipid-loaded cells were found in alveolar spaces, alveolar walls,, and perivascular interstitial tissue. No similar deposits were seen in infants with RDS who died without receiving surfactant. The reason for treatment failure is not explained by the present autopsy findings, but it seems likely that the accumulation of lipids is secondary to surfactant treatment. The possibility that macrophage function might, in some infants, be hampered by overloading with surfactant lipids, needs to be considered.
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Seqerer, H., Vogel, M., Obladen, M. et al. PULMONARY LIPID DEPOSITS AFTER SURFACTANT SUBSTITUTION FOR NEONATAL RESPIRATORY DISTRESS SYNDROME (RDS). Pediatr Res 26, 511 (1989). https://doi.org/10.1203/00006450-198911000-00074
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DOI: https://doi.org/10.1203/00006450-198911000-00074