Surfactant phosphatidylcholine pool size in human neonates with congenital diaphragmatic hernia requiring ECMO☆☆☆

Abstract 

Objective We measured surfactant phosphatidylcholine (PC) pool size and half-life in human congenital diaphragmatic hernia (CDH) patients who required extracorporeal membrane oxygenation (ECMO). Study design Surfactant PC pool size and half-life were measured by endotracheal administration of deuterium-labeled dipalmitoylphosphatidylcholine in 8 neonates with CDH on ECMO (CDH-ECMO), in 7 neonates with meconium aspiration syndrome on ECMO (MAS-ECMO), and in 6 ventilated infants (NON-ECMO). Results Lung PC pool size in the CDH-ECMO group was 73 ± 17 mg/kg (mean ± SEM), which was not significantly different from the MAS-ECMO (50 ± 18 mg/kg) and the NON-ECMO group (69 ± 38 mg/kg). Surfactant PC concentration in tracheal aspirates was not different between groups (~6 mg/mL). However, the percentage of palmitic acid in surfactant PC was significantly lower in the MAS-ECMO (56.3%) and the NON-ECMO (55.8%) group compared with the CDH-ECMO (67.6%) group. Surfactant PC half-life (~24 hours) was not different between the groups. A correlation was found between the surfactant PC half-life and the duration of ECMO. Conclusions These data show no decreased surfactant PC pool size in high risk CDH patients who require ECMO. A shorter half-life of surfactant PC, indicating a faster turnover, may result in a faster improvement of the pulmonary condition during ECMO. (J Pediatr 2003;142:247-52)

Abbreviations:  CDH , Congenital diaphragmatic hernia, CV , Conventional ventilation, ECMO , Extracorporeal membrane oxygenation, 2H-DPPC , Deuterium-labeled dipalmitoylphosphatidylcholine, HFO , High-frequency ventilation, MAS , Meconium aspiration syndrome, PC , Phosphatidylcholine, RDS , Respiratory distress syndrome, SP-A , Surfactant protein A