Chiara Autilio1, Mercedes Echaide2, Alexandra Benachi3, Anne Marfaing-Koka4, Ettore D Capoluongo5, Jesús Pérez-Gil6, Daniele De Luca7. 1. Department of Biochemistry and Molecular Biology, Faculty of Biology, and Research Institut Hospital 12 de Octubre, Complutense University, Madrid, Spain; Clinical Molecular Biology Laboratory, Department of Clinical Molecular Diagnostics, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy. 2. Department of Biochemistry and Molecular Biology, Faculty of Biology, and Research Institut Hospital 12 de Octubre, Complutense University, Madrid, Spain. 3. Division of Obstetrics and Gynecology, A. Beclere Medical Center, South Paris University Hospitals, APHP, Paris, France. 4. Division of Hematology, A. Beclere Medical Center, South Paris University Hospitals, Assistance Publique-Hopitaux de Paris, Paris, France. 5. Clinical Molecular Biology Laboratory, Department of Clinical Molecular Diagnostics, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy. 6. Department of Biochemistry and Molecular Biology, Faculty of Biology, and Research Institut Hospital 12 de Octubre, Complutense University, Madrid, Spain. Electronic address: jperezgil@bio.ucm.es. 7. Division of Pediatrics and Neonatal Critical Care, A. Beclere Medical Center, South Paris University Hospitals, APHP, Paris, France.
Abstract
OBJECTIVE: To determine the diagnostic accuracy of the surfactant adsorption test (SAT) as a predictor for the need for surfactant replacement therapy in neonates with respiratory distress syndrome (RDS). STUDY DESIGN: Amniotic fluid samples were collected from 41 preterm neonates with RDS treated with continuous positive airway pressure (CPAP) and 15 healthy control term neonates. Purified porcine surfactant served as a further control. Lamellar bodies and lung ultrasound score were also measured in a subset of the neonates treated with CPAP. Surfactant was administered according to the European guidelines, and clinical data were collected prospectively. Surfactant activity was measured as adsorption at the air/liquid interface and given in relative fluorescent units (RFU). RESULTS: Surfactant activity differed among native porcine surfactant (median, 4863 RFU; IQR, 4405-5081 RFU), healthy term neonates (median, 2680 RFU; IQR, 2069-3050 RFU), and preterm neonates with RDS (median, 442 RFU; IQR, 92-920 RFU; P <.0001). The neonates who failed CPAP had lower surfactant activity compared with those who did not fail CPAP (median, 92 RFU; IQR, 0-315 RFU vs 749 RFU; IQR, 360-974 RFU; P = .0002). Differences between groups were more evident beyond 20-30 minutes of fluorescence; the 30-minute time point showed the highest area under the curve (0.84; P <.001) and the best cutoff level (170 RFU; specificity, 72%; sensitivity, 96%) for the prediction of CPAP failure. Surfactant activity at 30 minutes was significantly correlated with lamellar bodies (r = 0.51, P = .006) and lung ultrasound score (r = -0.39, P = .013). CONCLUSION: This technique has the potential to be developed into a fast, simple-to-interpret clinical test. The SAT can reliably identify preterm infants with subsequent CPAP failure and shows promise as a screening test for surfactant replacement in preterm neonates.
OBJECTIVE: To determine the diagnostic accuracy of the surfactant adsorption test (SAT) as a predictor for the need for surfactant replacement therapy in neonates with respiratory distress syndrome (RDS). STUDY DESIGN: Amniotic fluid samples were collected from 41 preterm neonates with RDS treated with continuous positive airway pressure (CPAP) and 15 healthy control term neonates. Purified porcine surfactant served as a further control. Lamellar bodies and lung ultrasound score were also measured in a subset of the neonates treated with CPAP. Surfactant was administered according to the European guidelines, and clinical data were collected prospectively. Surfactant activity was measured as adsorption at the air/liquid interface and given in relative fluorescent units (RFU). RESULTS: Surfactant activity differed among native porcine surfactant (median, 4863 RFU; IQR, 4405-5081 RFU), healthy term neonates (median, 2680 RFU; IQR, 2069-3050 RFU), and preterm neonates with RDS (median, 442 RFU; IQR, 92-920 RFU; P <.0001). The neonates who failed CPAP had lower surfactant activity compared with those who did not fail CPAP (median, 92 RFU; IQR, 0-315 RFU vs 749 RFU; IQR, 360-974 RFU; P = .0002). Differences between groups were more evident beyond 20-30 minutes of fluorescence; the 30-minute time point showed the highest area under the curve (0.84; P <.001) and the best cutoff level (170 RFU; specificity, 72%; sensitivity, 96%) for the prediction of CPAP failure. Surfactant activity at 30 minutes was significantly correlated with lamellar bodies (r = 0.51, P = .006) and lung ultrasound score (r = -0.39, P = .013). CONCLUSION: This technique has the potential to be developed into a fast, simple-to-interpret clinical test. The SAT can reliably identify preterm infants with subsequent CPAP failure and shows promise as a screening test for surfactant replacement in preterm neonates.
Authors: Javier Rodriguez-Fanjul; I Jordan; M Balaguer; A Batista-Muñoz; M Ramon; S Bobillo-Perez Journal: Eur J Pediatr Date: 2020-07-24 Impact factor: 3.183
Authors: Daniele De Luca; Paola Cogo; Martin C Kneyber; Paolo Biban; Malcolm Grace Semple; Jesus Perez-Gil; Giorgio Conti; Pierre Tissieres; Peter C Rimensberger Journal: Crit Care Date: 2021-02-22 Impact factor: 9.097