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Decreased surfactant phosphatidylcholine synthesis in neonates with congenital diaphragmatic hernia during extracorporeal membrane oxygenation.

Authors :
Janssen DJ
Zimmermann LJ
Cogo P
Hamvas A
Bohlin K
Luijendijk IH
Wattimena D
Carnielli VP
Tibboel D
Source :
Intensive care medicine [Intensive Care Med] 2009 Oct; Vol. 35 (10), pp. 1754-60. Date of Electronic Publication: 2009 Jul 07.
Publication Year :
2009

Abstract

Purpose: Congenital diaphragmatic hernia (CDH) may result in severe respiratory insufficiency with a high morbidity. The role of a disturbed surfactant metabolism in the pathogenesis of CDH is unclear. We therefore studied endogenous surfactant metabolism in the most severe CDH patients who required extracorporeal membrane oxygenation (ECMO).<br />Methods: Eleven neonates with CDH who required ECMO and ten ventilated neonates without significant lung disease received a 24-h infusion of the stable isotope [U-(13)C] glucose. The (13)C-incorporation into palmitic acid in surfactant phosphatidylcholine (PC) isolated from serial tracheal aspirates was measured. Mean PC concentration in epithelial lining fluid (ELF) was measured during the first 4 days of the study.<br />Results: Fractional surfactant PC synthesis was decreased in CDH-ECMO patients compared to controls (2.4 +/- 0.33 vs. 8.0 +/- 2.4%/day, p = 0.04). The control group had a higher maximal enrichment (0.18 +/- 0.03 vs. 0.09 +/- 0.02 APE, p = 0.04) and reached this maximal enrichment earlier (46.7 +/- 3.0 vs. 69.4 +/- 6.6 h, p = 0.004) compared to the CDH-ECMO group, which reflects higher and faster precursor incorporation in the control group. Surfactant PC concentration in ELF was similar in both groups.<br />Conclusion: These results show that CDH patients who require ECMO have a decreased surfactant PC synthesis, which may be part of the pathogenesis of severe pulmonary insufficiency and has a negative impact on weaning from ECMO.

Details

Language :
English
ISSN :
1432-1238
Volume :
35
Issue :
10
Database :
MEDLINE
Journal :
Intensive care medicine
Publication Type :
Academic Journal
Accession number :
19582395
Full Text :
https://doi.org/10.1007/s00134-009-1564-7