Aim of the study was to evaluate the efficacy on arterial oxygenation of BAL with an FRC-like volume of diluted (10%) surfactant solution, followed by bovine surfactant (Alveofact) administration (50 mg/kg), in neonates with pulmonary infection.

Methods: two groups of patients received BAL. Group 1: 7 neonates of mean gestational age (GA) 26.3 weeks (24-31), mean birth weight(BW) 937 g (770-1500) with chronic lung disease (CLD) complicated by pulmonary infection, underwent BAL at mean 40 days of postnatal age (27-57).Group 2: 3 neonates of mean GA 35 weeks (30-39), mean BW 2500g(1650-2950), with pneumonia, underwent BAL at mean postnatal age 2 days (2-3). Both groups were mechanically ventilated and vital parameters continuously monitored; changes in arterial oxygen tension (PaO2), alveolar-arterial oxygen difference (AaDO2), oxygenation index (OI) and FiO2 were measured both pre and 2 hours post BAL. The solution used was about 10% natural bovine surfactant (100 mg/kg) in saline (20 ml/kg); the BAL was rapidly performed using a 5 French cateter via the endotracheal tube and an average 80% of solution was recovered. The procedure lasted about 1-2 minutes.

Results The manoeuvre was well tolerated (changes in heart rate and arterial oxygen saturation were<5%); after 2 hours all cases presented increased arterial oxygenation (mean values are shown in Table) and improved chest x rays. Two neonates needed to repeat BAL after 24-48 hours.

Table 1
Full size table

Conclusion BAL with diluted surfactant solution allows removal of accumulated inflammatory debris and pathogenic micro-organisms and it therefore permits a more homogeneous distribution of exogenous surfactant. Our data show an improvement in oxygenation with subsequent possibilities for reducing ventilatory support.