1-palmitoyl-2-oleoylphosphatidylcholine and Chronic-Disease

To determine whether dexamethasone 'matures' the phosphatidylcholine (PC) composition of broncheoalveolar fluid in infants at high risk of neonatal chronic lung disease (CLD), either by increasing the proportion of dipalmitoylphosphatidylcholine (DPPC), expressed as a percentage of total PC (%DPPC), or by increasing the ratio of DPPC to palmitoyloleoylphosphatidylcholine (DPPC:POPC ratio).. Double blind, placebo controlled.. Sixteen infants < 32 weeks' gestation, < 1250 g birth weight who were dependent on mechanical ventilation and requiring a fractional inspired oxygen of > 0.30 at 12 days of chronological age.. Randomisation to receive a two week reducing course of dexamethasone base at an initial dose of 0.2 mg/kg three times a day, or equivalent volumes of normal saline, starting at 14 days. Eight infants were randomised into each group. Broncheoalveolar lavage was performed serially throughout the study period or until extubation. PC composition of the fluid was analysed by high performance liquid chromatography.. The %DPPC and the DPPC:POPC ratios were calculated for individual infants for days -1 and 0 combined, days 1 and 3 combined, and days 5 and 7 combined. Analysis of covariance was used to analyse the results.. The DPPC:POPC ratio was significantly less in the treated group than the placebo group on days 1 and 3, and not greater as the hypothesis stated. Three out of five infants treated with dexamethasone and for whom data were available showed a substantial rise in DPPC:POPC ratio on days 5/7, compared with the placebo group, but overall these changes were not statistically significant.. The data do not support the hypothesis that dexamethasone's action in producing a clinical improvement within the first 72 hours of treatment for neonatal CLD is by the 'maturation' of pulmonary surfactant PC.

Topics: 1,2-Dipalmitoylphosphatidylcholine; Analysis of Variance; Chronic Disease; Dexamethasone; Double-Blind Method; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Lung Diseases; Phosphatidylcholines; Pulmonary Surfactants; Time Factors

The phosphatidylcholine (PC) content of the initial endotracheal tube aspirate was measured in 105 infants intubated for resuscitation or for ventilation for respiratory distress syndrome, using high performance liquid chromatography and postcolumn fluorescence derivitization with diphenyl-1,3,5-hexatriene. Sixty eight had measurable PC. Of the infants who developed respiratory distress syndrome, with or without subsequent chronic lung disease, neither the percentage of dipalmitoylphosphatidylcholine (DPPC) nor the ratio of DPPC to palmitoyloleoylphosphatidylcholine (POPC), showed any correlation with gestational age. However, both parameters were significantly lower overall in this group than in the group of infants who did not develop respiratory distress syndrome. Infants with a ratio of DPPC:POPC less than 3.0 developed respiratory distress syndrome irrespective of gestational age, but there was considerable overlap between groups for values greater than this. The infants with respiratory distress syndrome who went on to develop chronic lung disease had the same initial PC profile as those with respiratory distress syndrome who did not develop chronic lung disease, but differed as a group by being lighter and more premature. The development of chronic lung disease was not associated with a particular initial PC composition. Other factors related to increasing prematurity must therefore be involved in rendering infants vulnerable to developing chronic lung disease.

Topics: 1,2-Dipalmitoylphosphatidylcholine; Chromatography, High Pressure Liquid; Chronic Disease; Gestational Age; Humans; Infant; Infant, Newborn; Intubation, Intratracheal; Lung Diseases; Phosphatidylcholines; Pulmonary Surfactants; Respiratory Distress Syndrome, Newborn