Surfactant Therapy for Early Onset Pneumonia in Late Preterm and Term Neonates Needing Mechanical Ventilation
Introduction: Pathophysiology of pneumonia involves leakage of plasma proteins into the airways and accumulation of cytokines within the lung. Several in vitro and in vivo studies have demonstrated that this proteinaceous material and lung inflammation inhibit surfactant function. Aim: To evalu...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2017-08-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/10520/28523_CE(RA1)_F(T)_PF1_(NE_VT_PY)_PFA(NE_AP).pdf |
| Summary: | Introduction: Pathophysiology of pneumonia involves leakage
of plasma proteins into the airways and accumulation of
cytokines within the lung. Several in vitro and in vivo studies
have demonstrated that this proteinaceous material and lung
inflammation inhibit surfactant function.
Aim: To evaluate whether exogenous surfactant therapy improves
oxygenation and gas exchange in late preterm and term neonates
with early onset pneumonia and respiratory failure.
Materials and Methods: This prospective interventional cohort
study was conducted at a tertiary care neonatal unit. Twenty
four late preterm and term neonates with early onset pneumonia
requiring mechanical ventilation for respiratory failure were
included and received surfactant therapy. Oxygenation index,
arterial/alveolar PO2
(a/A ratio), mean airway pressure and
fraction of inspired oxygen were calculated from arterial blood
gases obtained before and after surfactant therapy. Wilcoxon
signed rank sum test was used for assessment of change in
oxygenation variables 12 hours after surfactant therapy. Data
regarding clinical outcomes and complications were collected
and analysed.
Results: Just over half (54.2%) of the study neonates were of
term gestation. After surfactant therapy, the median Oxygenation
Index (OI) decreased from 11.15 to 3.7 at one hour and the
change was sustained and significant at 12 hours (p<0.05). The
median a/A PO2
ratio improved from 0.09 to 0.3 within one hour
of surfactant replacement and the improvement was significant
at 12 hours (p<0.01). Twenty two neonates (92%) survived to
discharge. Median duration of hospital stay was 15 days.
Conclusion: Significant and rapid improvement in oxygenation
in late preterm and term neonates with early onset pneumonia
was seen after surfactant therapy, which is sustained for a
longer period. There could be a substantial role for the use of
surfactant in early onset pneumonia, although larger controlled
trials are needed before definite recommendations can be
made. |
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| ISSN: | 2249-782X 0973-709X |