Prenatal dexamethasone and exogenous surfactant therapy: surface activity and surfactant components in airway specimens

To explain some of the effects of prenatal glucocorticoid treatment on lung function, surfactant parameters in the airway specimens of ventilator-dependent preterm infants were analyzed. In this double-blind study, the mothers of these infants had received dexamethasone (DEX) or placebo prenatally. Human surfactant was given for the treatment of moderate to severe respiratory distress syndrome. Seventy-six preterm infants with mean gestational age of 29 wk and mean birth weight of 1137 g were studied. The concentrations of surfactant components in epithelial lining fluid (ELF) were analyzed, and the surface activity was measured using a pulsating bubble method. Prenatal DEX treatment increased the responsiveness to exogenous surfactant and decreased the severity of respiratory failure during the first day of life. The treatment had no effect on the concentrations of surfactant phospholipids that were generally high. Prenatal DEX treatment increased the association between phospholipid concentration in ELF and the degree of respiratory failure. Prenatal DEX improved the surface activity of surfactant isolated from airway specimens and tended to increase the ratio of surfactant protein A to phosphatidylcholine among recipients of exogenous surfactant. A subgroup of infants, offspring of mothers with severe hypertension had an abnormally low concentration of surfactant protein A and a poor outcome, despite prenatal DEX treatment or surfactant substitution. Prenatal DEX decreased the concentration of nonsedimentable proteins in ELF and decreased the inhibition of surface activity by these proteins. Our results indicate that improved surfactant function during the first day of life explains some of the beneficial pulmonary effects of prenatal glucocorticoid treatment in preterm infants who are ventilator-dependent.