RADIOLOGICAL CHANGES AFTER THERAPEUTIC USE OF SURFACTANT IN INFANTS WITH RESPIRATORY-DISTRESS SYNDROME

The aims of this study were to determine the incidence of typical ches t radiography findings - (1) uniform improvement, (2) asymmetrical imp rovement, (3) no improvement or (4) interstitial emphysema - after the rapeutic use of surfactant and to analyse clinical course and outcome. Chest radiographs of 138 infants of very low birth weight treated wit h surfactant were analysed. Twenty-eight infants with a diagnosis othe r than typical respiratory distress syndrome (RDS), i.e., sepsis, cong enital pneumonia and congenital malformation, were excluded. In 110 pa tients with clinical and radiological evidence of typical RDS (median gestational age 28 weeks, median birth weight 1070 g) adequate chest r adiographs from before and within 72 h after surfactant treatment were available. The time of surfactant application ranged between 1 and 12 h after birth. The most common finding after surfactant treatment was uniform or asymmetrical improvement of pulmonary aeration (80 of 110 patients). Patients with uniform clearing had the best long-term outco me. Asymmetrical clearance was often localised on the right side or in central regions of the lung, and usually disappeared after retreatmen t with surfactant without clinical significance. In 11 patients no cha nge in aeration was found and retreatment was absolutely ineffective. Development of pulmonary interstitial emphysema after surfactant treat ment was a grave prognostic sign: 73% of these infants died within the first 2 weeks of life compared with 10% of those with uniform or asym metrical improvement of ventilation.