Skip to main content
Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 1995 May;72(3):F176–F179. doi: 10.1136/fn.72.3.f176

Changes in pulmonary artery pressure in infants with respiratory distress syndrome following treatment with Exosurf.

A H Hamdan 1, N J Shaw 1
PMCID: PMC2528443  PMID: 7796233

Abstract

The pulmonary artery pressure (PAP) changes were studied using Doppler echocardiography in preterm infants treated with an artificial surfactant (Exosurf) during the acute phase of respiratory distress syndrome (RDS). The ratio of pulmonary artery acceleration time to the right ventricular ejection time (AT:RVET), measured from the Doppler wave form, was determined in 38 infants before the first dose of Exosurf, at one and six hours after the first dose, immediately before the second dose of Exosurf, and at one, six, 12, 36, and 60 hours subsequently. The median AT:RVET ratio corrected for heart rate (AT:RVET(c)) increased significantly an hour after administration of the first dose of Exosurf from 0.330 (0.273-0.410) to 0.380 (0.303-0.445) and similarly an hour after the second dose from 0.426 (0.252-0.495) to 0.440 (0.373-0.500). These changes occurred against a steady increase in the median AT:RVET(c) over the first 72 hours. It is concluded that the reduction in PAP correlates well with clinical parameters of disease severity and raises questions regarding the mode of action of Exosurf.

Full text

PDF
F178

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Akiba T., Yoshikawa M., Otaki S., Kobayashi Y., Nakasato M., Suzuki H., Sato T. Prediction of peak pulmonary artery pressure by continuous-wave Doppler echocardiography in infants and children. Pediatr Cardiol. 1988;9(4):225–229. doi: 10.1007/BF02078413. [DOI] [PubMed] [Google Scholar]
  2. Clyman R. I., Jobe A., Heymann M., Ikegami M., Roman C., Payne B., Mauray F. Increased shunt through the patent ductus arteriosus after surfactant replacement therapy. J Pediatr. 1982 Jan;100(1):101–107. doi: 10.1016/s0022-3476(82)80247-3. [DOI] [PubMed] [Google Scholar]
  3. Evans N. J., Archer L. N. Doppler assessment of pulmonary artery pressure and extrapulmonary shunting in the acute phase of hyaline membrane disease. Arch Dis Child. 1991 Jan;66(1 Spec No):6–11. doi: 10.1136/adc.66.1_spec_no.6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Evans N. J., Archer L. N. Doppler assessment of pulmonary artery pressure during recovery from hyaline membrane disease. Arch Dis Child. 1991 Jul;66(7 Spec No):802–804. doi: 10.1136/adc.66.7_spec_no.802. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Evans N. J., Archer L. N. Postnatal circulatory adaptation in healthy term and preterm neonates. Arch Dis Child. 1990 Jan;65(1 Spec No):24–26. doi: 10.1136/adc.65.1_spec_no.24. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Gill A. B., Weindling A. M. Pulmonary artery pressure changes in the very low birthweight infant developing chronic lung disease. Arch Dis Child. 1993 Mar;68(3 Spec No):303–307. doi: 10.1136/adc.68.3_spec_no.303. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Kitabatake A., Inoue M., Asao M., Masuyama T., Tanouchi J., Morita T., Mishima M., Uematsu M., Shimazu T., Hori M. Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique. Circulation. 1983 Aug;68(2):302–309. doi: 10.1161/01.cir.68.2.302. [DOI] [PubMed] [Google Scholar]
  8. Kosturakis D., Goldberg S. J., Allen H. D., Loeber C. Doppler echocardiographic prediction of pulmonary arterial hypertension in congenital heart disease. Am J Cardiol. 1984 Apr 1;53(8):1110–1115. doi: 10.1016/0002-9149(84)90646-5. [DOI] [PubMed] [Google Scholar]
  9. Käpä P., Kero P., Saraste M. Synthetic surfactant replacement therapy decreases estimated pulmonary artery pressure in respiratory distress syndrome. Am J Dis Child. 1992 Aug;146(8):961–964. doi: 10.1001/archpedi.1992.02160200083033. [DOI] [PubMed] [Google Scholar]
  10. Käpä P., Seppänen M., Kero P., Saraste M. Pulmonary hemodynamics after synthetic surfactant replacement in neonatal respiratory distress syndrome. J Pediatr. 1993 Jul;123(1):115–119. doi: 10.1016/s0022-3476(05)81553-7. [DOI] [PubMed] [Google Scholar]
  11. Long W., Corbet A., Cotton R., Courtney S., McGuiness G., Walter D., Watts J., Smyth J., Bard H., Chernick V. A controlled trial of synthetic surfactant in infants weighing 1250 g or more with respiratory distress syndrome. The American Exosurf Neonatal Study Group I, and the Canadian Exosurf Neonatal Study Group. N Engl J Med. 1991 Dec 12;325(24):1696–1703. doi: 10.1056/NEJM199112123252404. [DOI] [PubMed] [Google Scholar]
  12. Long W., Thompson T., Sundell H., Schumacher R., Volberg F., Guthrie R. Effects of two rescue doses of a synthetic surfactant on mortality rate and survival without bronchopulmonary dysplasia in 700- to 1350-gram infants with respiratory distress syndrome. The American Exosurf Neonatal Study Group I. J Pediatr. 1991 Apr;118(4 Pt 1):595–605. doi: 10.1016/s0022-3476(05)83388-8. [DOI] [PubMed] [Google Scholar]
  13. Martin-Duran R., Larman M., Trugeda A., Vazquez de Prada J. A., Ruano J., Torres A., Figueroa A., Pajaron A., Nistal F. Comparison of Doppler-determined elevated pulmonary arterial pressure with pressure measured at cardiac catheterization. Am J Cardiol. 1986 Apr 1;57(10):859–863. doi: 10.1016/0002-9149(86)90627-2. [DOI] [PubMed] [Google Scholar]
  14. Seppänen M. P., Käpä P. O., Kero P. O., Saraste M. Doppler-derived systolic pulmonary artery pressure in acute neonatal respiratory distress syndrome. Pediatrics. 1994 May;93(5):769–773. [PubMed] [Google Scholar]
  15. Serwer G. A., Cougle A. G., Eckerd J. M., Armstrong B. E. Factors affecting use of the Doppler-determined time from flow onset to maximal pulmonary artery velocity for measurement of pulmonary artery pressure in children. Am J Cardiol. 1986 Aug 1;58(3):352–356. doi: 10.1016/0002-9149(86)90076-7. [DOI] [PubMed] [Google Scholar]
  16. Skinner J. R., Boys R. J., Hunter S., Hey E. N. Non-invasive assessment of pulmonary arterial pressure in healthy neonates. Arch Dis Child. 1991 Apr;66(4 Spec No):386–390. doi: 10.1136/adc.66.4_spec_no.386. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Skinner J. R., Boys R. J., Hunter S., Hey E. N. Pulmonary and systemic arterial pressure in hyaline membrane disease. Arch Dis Child. 1992 Apr;67(4 Spec No):366–373. doi: 10.1136/adc.67.4_spec_no.366. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Stenson B. J., Glover R. M., Parry G. J., Wilkie R. A., Laing I. A., Tarnow-Mordi W. O. Static respiratory compliance in the newborn. III: Early changes after exogenous surfactant treatment. Arch Dis Child Fetal Neonatal Ed. 1994 Jan;70(1):F19–F24. doi: 10.1136/fn.70.1.f19. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood. Fetal and Neonatal Edition are provided here courtesy of BMJ Publishing Group

RESOURCES