The potential of exogenous replacement therapy in surfactant-deficient states such as neonatal respiratory distress syndrome (RDS) is an area of intense clinical interest today. At present, a fundamental problem with any type of exogenous surfactant is the uncertainty about potential effects on physiological defense mechanisms, such as differentiation and mobilization of peripheral leukocytes. Considering that newborn infants with proven bacterial infections have abnormal values of segmented (neutrophil) and nonsegmented (band) polymorphonuclear leukocytes, we studied 42 placebo- versus Curosurf-treated babies with severe RDS. Differential white blood cell (WBC) count was serially performed before and after treatment during the first days of life. The statistically significant increase in the proportion of bands in surfactant-treated babies did not coincide with clinical and bacteriologic evidence of possible infection. Some molecular interaction mechanisms influencing immature to mature WBC ratio are supposed. Among a variety of influences on the leukocyte count, surfactant replacement therapy needs to be considered for proper interpretation of hematologic data in babies treated for RDS.

Some trials in premature infants with respiratory distress syndrome have shown an increased incidence of patent ductus arteriosus after exogenous surfactant therapy. The effect of prophylactic ethamsylate on patent ductus arteriosus after intratracheal administration of a single dose of porcine surfactant preparation (Curosurf, 2.5 ml/kg) was studied in a group of 20 preterm infants with severe respiratory distress syndrome. Gestational age of the patients was 29.2 +/- 2.5 weeks (mean +/- SD), and birth weight was 1158 +/- 319 gm. Ethamsylate (12.5 mg/kg) was given prophylactically within the first 4 hours of life followed by 6-hourly doses for 4 days. Hemodynamically significant patent ductus arteriosus occurred more frequently in the untreated group (8 of 10) than in the ethamsylate group (2 of 10) (p < 0.02). No acute adverse effects were attributed to the therapy. This preliminary experience suggests that ethamsylate, an inhibitor of prostaglandin biosynthesis, could be useful in reducing the incidence of patent ductus arteriosus in very low birth weight infants treated with exogenous surfactant.

Acta PaediatricaVolume 81, Issue 4 p. 351-352 Prophylaxis of patent ductus arteriosus using ethamsylate in preterms treated with exogenous surfactant M Amato, M Amato Division of Neonatology. Department of Obstetrics and Gynecology, University of Berne, SwitzerlandSearch for more papers by this authorPS Hüppi, PS Hüppi Division of Neonatology. Department of Obstetrics and Gynecology, University of Berne, SwitzerlandSearch for more papers by this authorD Markus, D Markus Division of Neonatology. Department of Obstetrics and Gynecology, University of Berne, SwitzerlandSearch for more papers by this author M Amato, M Amato Division of Neonatology. Department of Obstetrics and Gynecology, University of Berne, SwitzerlandSearch for more papers by this authorPS Hüppi, PS Hüppi Division of Neonatology. Department of Obstetrics and Gynecology, University of Berne, SwitzerlandSearch for more papers by this authorD Markus, D Markus Division of Neonatology. Department of Obstetrics and Gynecology, University of Berne, SwitzerlandSearch for more papers by this author First published: April 1992 https://doi.org/10.1111/j.1651-2227.1992.tb12241.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume81, Issue4April 1992Pages 351-352 RelatedInformation

Parenteral human immunoglobulin (IVIG) administration is widely used in low birth weight (LBW) infants for prevention and therapy of neonatal infection. In previous studies, IVIG preparations containing IgG and low IgM concentrations were commonly used. In this study we compare immunoglobulin serum levels in two groups of healthy preterm infants receiving prophylactically standard IVIG (Sandoglobulin, 0.1 mg/kg IgM) or IgM-enriched IVIG (Pentaglobin, 30 mg/kg IgM). Immunoglobulin levels were assayed by rate nephelometry at birth and at 3, 5, 7, and 14 days after birth. The two groups of patients were matched for gestational age (31±2.3 weeks), birth weight (1320±340 g), and serum IgG (4.1±1.9 g/l) and IgM (0.22±0.18 g/l) levels at birth. Significantly higher IgM levels were observed at 3 and 5 days after IgM-enriched IVIG administration (p<0.01). Higher IgG levels were attained and persisted for 2 weeks after standard IVIG administration (p<0.01). These data indicate different IgG and IgM target levels in LBW infants treated with different immunoglobulin preparations.

Changes of cerebral blood flow were determined in 20 preterm infants undergoing blue-light phototherapy for hyperbilirubinemia. All were healthy very-low-birth-weight infants (less than 1,500 g) with normal brain sonograms and not under pharmacological treatment at the time of the investigation. Blood flow velocity (pulsatility index and area under velocity curve) was measured by Duplex Scan technique during and after phototherapy. No changes of global cerebral blood flow were observed in the anterior cerebral artery (p less than 0.5). Our results suggest no functional disturbance of cerebral autoregulation in low-birth-weight infants treated with phototherapy.

Surfactant replacement therapy in patients with neonatal respiratory distress syndrome (RDS) is a new therapeutic approach. There is now convincing evidence that the incidence and severity of RDS can be reduced. Surfactant (CUROSURF) was intratracheally applied to a group of fifteen intubated preterm infants with severe RDS (29 +/- 2.1 weeks of gestation and 1204 +/- 301 g birth weight) at 9.1 +/- 2.5 hours of life. For detection of potential neurological risk we performed serial ultrasound examinations (US), serial measurements of Creatine-Kinase Isoenzyme levels (CK-BB) looking for the presence of human antibodies to different brain antigens (BSA) as markers for neonatal cerebral injury. Using these diagnostic methods, there was no evidence of any negative influence of surfactant therapy on cerebral function of treated preterm infants.

Total serum bilirubin level was assessed in a group of jaundiced low birth weight infants using three different methods. Transcutaneous bilirubinometry was compared with conventional capillary and arterial methods to investigate the over-or underestimation of neonatal jaundice. Sampling site did not influence bilirubin levels. Capillary and arterial results showed a linear correlation (r = 0.9) suggesting no influence of environmental light on peripheral bilirubin isomerization. Similar results were obtained comparing both serum levels with transcutaneous values (r = 0.7). We conclude that treatment decisions may be made on the basis of one of the three mentioned methods in healthy low birth weight infants with neonatal jaundice.