HIGH-DOSE VERSUS LOW-DOSE BOVINE SURFACTANT TREATMENT IN VERY PREMATURE-INFANTS

被引:25
作者
GORTNER, L
POHLANDT, F
BARTMANN, P
BERNSAU, U
PORZ, F
HELLWEGE, H
SEITZ, RC
HIERONIMI, G
KUHLS, E
JORCH, G
REITER, HL
BAUER, J
VERSMOLD, H
MEILER, B
机构
[1] UNIV ULM,CHILDRENS HOSP,ULM,GERMANY
[2] PEDIAT HOSP,AUGSBURG,GERMANY
[3] UNIV HAMBURG,CHILDRENS HOSP,HAMBURG,GERMANY
[4] OLGA HOSP,CTR PEDIAT,STUTTGART,GERMANY
[5] UNIV MUNSTER,CHILDRENS HOSP,MUNSTER,GERMANY
[6] UNIV GIESSEN,CHILDRENS HOSP,GIESSEN,GERMANY
[7] UNIV MUNICH,MUNICH,GERMANY
关键词
BOVINE SURFACTANT; OXYGENATION; PULMONARY INTERSTITIAL EMPHYSEMA; RESPIRATORY DISTRESS SYNDROME; VERY PREMATURE INFANTS;
D O I
10.1111/j.1651-2227.1994.tb13036.x
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
The aim of the study was to determine if high-dose bovine surfactant (Alveofact, initially 100 mg/kg birth weight) would improve oxygenation compared with low-dose surfactant (50 mg/kg birth weight) administered intratracheally within 1 h after birth. Inclusion criteria included gestational age 24-29 weeks and birth weight 500-1500 g, intubation and mechanical ventilation, absence of congenital malformations and bacterial infections. Retreatment was considered if the fraction of inspired oxygen (FiO(2)) was > 0.4 (dose 50 mg/kg birth weight). The primary endpoint was level of oxygenation (PaO2/FiO(2)) 2 h after treatment. The study design was a sequential analysis using a triangular test with alpha = 0.05 and 95% power to detect a 25% improvement in the endpoint. Oxygenation was improved significantly with high-dose (n = 42) compared to low-dose treatment (n = 48): 30.9 +/- 15.0 kPa (231.5 +/- 112.7 mmHg) versus 24.1 +/- 15.7 kPa (180.6 +/- 118.0 mmHg) (mean +/- SD). The survival rate was 83% in both groups and the incidence of pulmonary interstitial emphysema was 33% versus 14% with the high-dose treatment. We conclude that high-dose surfactant significantly improved oxygenation and reduced lung barotrauma. An initial dose greater than 50 mg/kg birth weight of surfactant is required for optimal acute response.
引用
收藏
页码:135 / 141
页数:7
相关论文
共 33 条
  • [1] NEONATAL PULMONARY MANIFESTATIONS DUE TO PROLONGED AMNIOTIC LEAK
    BHUTANI, VK
    ABBASI, S
    WEINER, S
    [J]. AMERICAN JOURNAL OF PERINATOLOGY, 1986, 3 (03) : 225 - 230
  • [2] ENHORNING G, 1985, PEDIATRICS, V76, P145
  • [3] FUJIWARA T, 1990, PEDIATRICS, V138, P8
  • [4] GITLIN JD, 1987, PEDIATRICS, V79, P31
  • [5] EFFECTS OF BOVINE SURFACTANT IN PREMATURE LAMBS AFTER INTRA-TRACHEAL APPLICATION
    GORTNER, L
    POHLANDT, F
    DISSE, B
    WELLER, E
    [J]. EUROPEAN JOURNAL OF PEDIATRICS, 1990, 149 (04) : 280 - 283
  • [6] EARLY TREATMENT OF RESPIRATORY-DISTRESS SYNDROME WITH BOVINE SURFACTANT IN VERY PRETERM INFANTS - A MULTICENTER CONTROLLED CLINICAL-TRIAL
    GORTNER, L
    BARTMANN, P
    POHLANDT, F
    BERNSAU, U
    PORZ, F
    HELLWEGE, HH
    SEITZ, RC
    HIERONIMI, G
    BREMER, C
    JORCH, G
    HENTSCHEL, R
    REITER, HL
    WOLF, H
    BALL, F
    [J]. PEDIATRIC PULMONOLOGY, 1992, 14 (01) : 4 - 9
  • [7] GORTNER L, 1990, MONATSSCHR KINDERH, V138, P274
  • [8] EXOGENOUS HUMAN SURFACTANT FOR TREATMENT OF SEVERE RESPIRATORY-DISTRESS SYNDROME - A RANDOMIZED PROSPECTIVE CLINICAL-TRIAL
    HALLMAN, M
    MERRITT, TA
    JARVENPAA, AL
    BOYNTON, B
    MANNINO, F
    GLUCK, L
    MOORE, T
    EDWARDS, D
    [J]. JOURNAL OF PEDIATRICS, 1985, 106 (06) : 963 - 969
  • [9] HOEKSTRA RE, 1991, PEDIATRICS, V88, P10
  • [10] HORBAR JD, 1989, NEW ENGL J MED, V320, P959