At. Gibson et Ra. Primhak, EARLY CHANGES IN LUNG-FUNCTION AND RESPONSE TO SURFACTANT REPLACEMENTTHERAPY, European journal of pediatrics, 153(7), 1994, pp. 495-500
Dynamic respiratory system compliance (Cdyn) was measured in 44 preter
m babies before, immediately after, and for 96 h following administrat
ion of artificial surfactant (Exosurf). There was no significant chang
e in Cdyn for the whole group over the entire study period. Subdivisio
n into three groups on the basis of Cdyn prior to surfactant revealed
a significant and sustained deterioration in lung function in those ba
bies with the highest starting compliance and a significant and sustai
ned improvement in those with the lowest compliance. Inspired oxygen a
nd alveolar/arterial oxygen gradient also exhibited significant differ
ences with least improvement in the babies with the best initial lung
function and most improvement in the babies with worst initial lung fu
nction. Despite clear initial differences in clinical status, neither
long-term oxygen requirements nor the incidence of chronic lung diseas
e differed significantly between the three groups. We conclude that th
e response of an individual baby to the administration of surfactant i
s, in part, determined by the lung function before surfactant is admin
istered. Babies with higher initial lung compliance are more likely to
deteriorate after administration and caution should be used before se
lection of such babies for surfactant treatment.