Abstract
There is evidence to suggest that small airway closure may be involved in ALTE1. We present data from 2 infants who showed an abnormally high surface tension of their pulmonary surfactant. The first of these infants (MS) presented at 2 months of age with a history of severe cyanotic episodes starting one week prior to admission to our unit. One of these episodes could be documented and showed an extremely rapid fall in arterial oxygen saturation to 40%, but no apnoea. The second infant, a 4 month old boy, had had a history of 3 cyanotic episodes requiring intubation prior to admission to our unit. Both infants underwent bronchoscopy because of suspected upper airway obstruction (which could not be confirmed). During this procedure, a broncho-alveolar lavage (BAL) was performed. Analysis of the physical properties of the surfactant recovered from the BAL showed a normally shaped, but upward shifted hysteresis curve (analysis performed by bubble-surfactometry). Minimal surface tension was 21 and 32 mN/m, respectively. In two controll infants of similar age, minimal surface tension was 9 and 11 mN/m, respectively.
These data suggest that an abnormally high surface tension of the pulmonary surfactant, facilitating small airway closure, may have been involved in the pathogenesis of the severe and otherwise unexplained ALTE in these infants. Whether this potential pathomechanism may also play a role in other infants with ALTE deserves further investigation.
1 Poets CF, Samuels MP, Southall DP. The potential role of intrapulmonary shunting in the pathogenesis of hypoxemic episodes in infants and young children. Pediatrics 1992;90:385-391
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Poets, C., Martin, I., Acevedo, C. et al. 355 ABNORMALLY HIGH SURFACE TENSION OF LUNG SURFACTANT IN 2 INFANTS WITH SEVERE APPARENT LIFE-THREATENING EVENTS (ALTE). Pediatr Res 36, 62 (1994). https://doi.org/10.1203/00006450-199407000-00355
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DOI: https://doi.org/10.1203/00006450-199407000-00355