OBSERVATIONS ON LIPOSOME SUBSTITUTION IN PRETERM INFANTS WITH RESPIRATORY DISTRESS SYNDROME (RDS)

Abstract

Surface active large unilamellar vesicles containing 80% dipalmitoylphosphatidylcholine and 20% phosphatidylglycerol were injected into the tracheal tube of 6 preterm infants (birth weight 820-1230 g)with severe RDS and poor prognosis. Entry criteria for the pilot study were:Respiratory failure x ray grade >2, gestational age <30 weeks,weight <1500 g,age <6 hours,parental informed consent. The phospholipid lung profile was studied in tracheal aspirates, tidal volume was measured by pneumotachography. - Neonatal courses were highly variable,probably due to different age and degree of RDS at the time of substitution. No infant showed complete and continuing recovery immediately after phospholipid application. 4 newborns survived. No patent ductus, but 2 pneumothoraces were observed.After a short initial decrease,tidal volume increased from 4 to 8 ml/kg and compliance from 0.3 to 0.6 ml/cm H₂O/kg in 3 infants within 6 hours after treatment. In two of them, FiO₂ could be reduced from 1.0 to .25 within few hours, in one of them respiratory failure returned after 24 hours. The other showed a dramatic improvement of compliance and oxygenation, but died at the age of 46 hours from intraventricular hemorrhage.One infant did not respond to substitution and died at 16 hours from hypoxia.In two infants treated at 3-5 hours of age, an increase of tidal volume and oxygenation did not occur until 6-24 hours after substitution.Phosphatidylglycerol was detectable in tracheal aspirates 24 hours to 4 days after liposome application.

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