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Premature infants with lung disease may continue to need replacement substance to ease breathing

Physicians have known for decades that many premature babies suffer respiratory problems stemming from insufficiency of a lung substance called surfactant during their first few weeks of life. The standard treatment has been to provide replacement surfactant immediately after birth. A new study has found that even after infants begin producing their own surfactant, it often fails to function properly in premature infants who continue to have lung disease after their first week.

The study also raises the question of whether additional replacement surfactant treatment may benefit such infants, just as it does in the week after birth.

Neonatology researchers from The Children's Hospital of Philadelphia and the University of Pennsylvania published the study in the October 20 online edition of the journal Pediatric Research. It was the first study of surfactant dysfunction in infants beyond the first week of life.

"We studied premature babies who require mechanical ventilation to breathe after one week of age," said Philip L. Ballard, M.D., Ph.D., director of Neonatology Research at The Children's Hospital of Philadelphia. "We found that three-quarters of these high-risk infants have episodes of surfactant dysfunction, and these episodes are associated with worsening of their respiratory status."

Surfactant is a naturally produced mixture of proteins and lipids (fats) that lowers surface tension within alveoli, the tiny air sacs within the lungs. By doing so, it prevents the alveoli from collapsing during exhalation, and eases the work of breathing. Premature infants have underdeveloped respiratory systems and do not produce enough of their own surfactant. Therefore, physicians have found that supplying replacement surfactant may improve infants' lung function during the earliest period after birth.

Replacement surfactant is discontinued after babies begin to produce enough surfactant on their own. However, infants wi
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Contact: John Ascenzi
ascenzi@email.chop.edu
267-426-6055
Children's Hospital of Philadelphia
15-Nov-2004


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