Procedure for preemies effective, New England Journal reports

By LOIS BAKER
News Services Editor

A five-center trial of partial liquid ventilation to treat life-threatening respiratory distress syndrome in extremely premature infants has shown that the procedure is safe and effective, and improves lung function in some children who failed to respond to conventional treatment, increasing their chances of survival.

Corrine Leach, UB assistant professor of pediatrics, headed the multi-center investigation of the procedure, which was developed by Bradley Fuhrman, UB professor of pediatrics. Leach and Fuhrman also are affiliated with the Children's Hospital of Buffalo.

Respiratory distress syndrome, the leading cause of death in premature infants, develops because the lungs of these tiny babies have yet to secrete surfactant, the substance that prevents the air sacs from collapsing. Conventional therapy for this condition-increasing the pressure and oxygen concentration inside the lung in an effort to force more oxygen into the blood stream-can cause permanent lung damage and result in a chronic disease called bronchopulmonary dysplasia.

Partial liquid ventilation involves introducing an oxygen-rich liquid called perflubron into the baby's lungs. The liquid allows the lungs to inflate with less pressure than air, and permits oxygen and carbon dioxide to pass through the air sacs and into the blood stream more easily and efficiently.

"The successful introduction of liquid into the lung and the ability of infants to breathe with liquid allows us to ventilate the lung at lower pressure, which causes less damage," Leach said. "If we can decrease the amount of lung injury, we can greatly improve the patient's outcome and perhaps prevent chronic lung disease."

The pilot study involved 13 infants born between 24-34 weeks of gestation. All had failed to respond to conventional therapy and were at risk of dying.

Carbon-dioxide levels improved in all patients while on PLV and lung functioning improved in 11 infants.

Seven of the 13 critically ill infants survived. Of those who died, three succumbed to their acute lung disease, and one from bronchopulmonary dysplasia. Two patients died of non-respiratory complications of prematurity.

Clinical trials using PLV to treat children and adults with severe respiratory distress syndrome are now under way and results are promising, Leach said.