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Background: Respiratory insufficiency in neonates with congenital diaphragmatic hernia (CDH), meconium aspiration syndrome (MAS) or other forms of persistent pulmonary hypertensin of the newborn (PPHN) is frequently so severe that extracorporeal membrane oxygenation (ECMO) is needed. Although disturbances in surfactant function have been described, the metabolism of surfactant has not been studied on ECMO.

Aim: To study endogenous surfactant metabolism with the use of stable isotopes in neonates with severe respiratory insufficiency with CDH, MAS or PPHN requiring ECMO in comparison to ventilated term controls without significant lung disease.

Methods: All patients received a 24 h infusion with [U-13 C] glucose to study label incorporation into palmitate groups of surfactant phosphatidylcholine isolated from sequential tracheal aspirates. Kinetic parameters were calculated from the 13 C …