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Chapter 16

Chapter 16. Surfactant Replacement Therapy. History of Surfactant Replacement. LaPlace: early nineteenth century Von Neergaard:1929 Macklin:1949 Mead:1950s Prattle:1955 Avery and Mead:1959 Fujiwara:1980. Surfactant Physiology. Any molecule that localizes on aqueous surfaces

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Chapter 16

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  1. Chapter 16 Surfactant Replacement Therapy

  2. History of Surfactant Replacement LaPlace: early nineteenth century Von Neergaard:1929 Macklin:1949 Mead:1950s Prattle:1955 Avery and Mead:1959 Fujiwara:1980

  3. Surfactant Physiology Any molecule that localizes on aqueous surfaces Creates an air-liquid interface and reduces surface tension Water molecules pushed apart Prevent alveolar collapse during exhalation

  4. Surfactant Physiology (cont.)

  5. Surfactant Metabolism and Composition

  6. Surfactant Composition

  7. Hormonal Effects Antenatal steroids Thyroid hormones

  8. Fetal Lung Maturity

  9. Surfactant Dysfunction

  10. Clinical Application and Replacement RDS Treatment Prophylaxis Rescue and multiple treatments Natural vs synthetic Nonresponders

  11. Clinical Application and Replacement (cont.) Pulmonary hemorrhage Meconium aspiration syndrome Pneumonia and sepsis Congenital diaphragmatic hernias

  12. Clinical Application and Replacement (cont.)

  13. Clinical Application and Replacement (cont.) ARDS Viral bronchiolitis Asthma Cystic fibrosis

  14. Future Directions Administration with LMA Genetically engineered surfactant-associated proteins Understanding of individual genetic polymorphism

  15. Case 16.1 800-gm 26-week gestation baby boy Spontaneous vaginal delivery due to cervical incompetence Apgar score of 51 and 65 Positive pressure ventilation (PPV)

  16. Case 16.1 (cont.) Grunting NCPAP of 5 cm H2O First arterial blood gas at 30 minutes of life on 70% oxygen is: pH 7.10, pCO2 78 mm Hg, pO2 52 mm Hg

  17. Case 16.2 A full-term infant Stat C-section for fetal heart rate decelerations Thick meconium Suction by OB Endotracheal intubation/suctioned the airway

  18. Case 16.2 (cont.) Significant grunting and intercostals retractions Placed on high-frequency oscillatory ventilation Requires an FIO2 of 1.0 Preductal saturations of 90%; postductal saturations of 85% Chest radiograph: bilateral streaky densities throughout the lung fields

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