21 Surfactant Dipalmitoyl Phosphatidylcholine Kinetic is Markedly Impaired in Term Newborns with Pneumonia

Abstract

Background and aims: The efficacy of exogenous surfactant treatment in term newborns with pneumonia is still undetermined. Aim of the study is to assess surfactant dipalmitoyl phosphatidylcholine (DPPC) kinetics in newborns with pneumonia using U¹³C-DPPC as tracer.

Methods: Nineteen full-term newborns requiring mechanical ventilation were enrolled: 9 had severe pneumonia and 10 no lung disease. Gestational age and birth weights were similar (38.3 ± 2.0 wks and 2782 ± 724 g). All newborns received intratracheally 2 mg kg⁻¹ U¹³C-DPPC mixed with 2 to 5 mg kg⁻¹ of exogenous surfactant. We collected sequential tracheal aspirates from the start of the study (before the tracer administration) and isotopic enrichments of DPPC palmitate moieties were measured from serial tracheal aspirates by gas chromatography mass spectrometry. Data are expressed as median (interquartile range) and comparisons are performed by Mann-Whitney test. p< 0.05 was regarded as statistically significant.

Results: Median and interquartile range of DPPC pool size in newborns with pneumonia was 3 mg kg⁻¹ (1.5-14.0) and 26.7 mg kg⁻¹ (18.3-44.0) in control group. The difference was statistically significant (p=0.041). Median DPPC half life was 10.1 h (7.6-13.9) in pneumonia and 22.5 h (18.2-36.1) in controls. The difference was highly significant (p=0.004).

Conclusions: Term newborns with pneumonia exhibited a smaller pool size and shorter DPPC half life than controls suggesting a markedly faster surfactant turnover presumably triggered by neonatal pneumonia.

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