Late administration of surfactant replacement therapy increases surfactant protein-B content: A randomized pilot study

Roberta L. Keller, Jeffrey D. Merrill, Dennis M. Black, Robin H Steinhorn, Eric C. Eichenwald, David J. Durand, Rita M. Ryan, William E. Truog, Sherry E. Courtney, Philip L. Ballard, Roberta A. Ballard

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: Surfactant dysfunction may contribute to the development of bronchopulmonary dysplasia (BPD) in persistently ventilated preterm infants. We conducted a multicenter randomized, blinded, pilot study to assess the safety and efficacy of late administration of doses of a surfactant protein-B (SP-B)-containing surfactant (calfactant) in combination with prolonged inhaled nitric oxide (iNO) in infants 1,000 g birth weight (BW). Methods: We randomized 85 preterm infants ventilated at 7-14 d after birth to receive either late administration of surfactant (up to 5 doses) plus prolonged iNO or iNO alone. Large aggregate surfactant was isolated from daily tracheal aspirates (TAs) for measurement of SP-B content, total protein, and phospholipid (PL).Results:Late administration of surfactant had minimal acute adverse effects. Clinical status as well as surfactant recovery and SP-B content in tracheal aspirate were transiently improved as compared to the controls; these effects waned after 1 d. The change in SP-B content with surfactant dosing was positively correlated with SP-B levels during treatment (r = 0.50, P = 0.02). Conclusion: Low SP-B values increased with calfactant administration, but the relationship of this response to SP-B levels suggests that degradation is a contributing mechanism for SP-B deficiency and surfactant dysfunction. We conclude that late therapy with surfactant in combination with iNO is safe and transiently increases surfactant SP-B content, possibly leading to improved short-and long-term respiratory outcomes.

Original languageEnglish (US)
Pages (from-to)613-619
Number of pages7
JournalPediatric Research
Issue number6
StatePublished - Dec 2012
Externally publishedYes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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