RESUMO
We performed a randomized, prospective clinical trial comparing intratracheal administration of human surfactant with conventional treatment with intermittent mandatory mechanical ventilation alone for treatment of severe respiratory distress syndrome in preterm infants of less than 30 weeks gestation. Twenty-two infants (mean gestational age 27.0 weeks, mean birth weight 987 gm) were given surfactant, and 23 infants (mean gestational age 27.2 week, mean birth weight 1055 gm) received intermittent mandatory ventilation. Infants given surfactant required less FiO2 during the first week, had lower mean airway pressure during the first 48 hours, and had improved ventilatory index and a/A PO2 ratio. Death or the occurrence of bronchopulmonary dysplasia was significantly less among infants given surfactant (P = 0.019). Pneumothorax, pulmonary interstitial emphysema, and need for FiO2 greater than or equal to 0.3 for greater than 30 days was significantly less in the surfactant group. This trial confirms the efficacy of treatment with human surfactant in preterm infants with severe respiratory distress syndrome.
Assuntos
Líquido Amniótico , Doenças do Prematuro/terapia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Tensoativos/uso terapêutico , Líquido Amniótico/análise , Peso ao Nascer , Ensaios Clínicos como Assunto , Feminino , Humanos , Recém-Nascido , Doenças do Prematuro/mortalidade , Masculino , Estudos Prospectivos , Distribuição Aleatória , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Fatores de TempoRESUMO
Prefeeding and sequential postprandial plasma amino acid concentrations were measured in 31 healthy preterm infants with gestational ages between 33 and 37 weeks at the ages of 4 to 12 days, to characterize changes after quantitatively and qualitatively different protein loads. All infants had previously been fed with human milk. The infants received a normal feed of pooled human milk (true protein 0.8 gm/dl) or of adapted or nonadapted milk formula (protein 1.5 gm/dl) from a bottle. The concentrations of all essential and several nonessential amino acids, including arginine and ornithine, rose sharply in plasma. Glycine decreased, and alanine increased slowly. Postprandial alterations in plasma total amino acids seemed to reflect the protein content of the different milks. In preterm infants, fed at three- to four-hour intervals, plasma amino acid concentrations fluctuate continuously. Thus in long-term studies and in screening, samples should be taken immediately before feeds. Postprandial plasma amino acid measurements may prove to be a useful means for testing the infant's ability to handle the protein or individual amino acid loads in various feeds.