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Diseases of alveolar homeostasis
Jeffrey A. Whitsett (pdf 117 kb) |
An overview of pulmonary surfactant structure and function, focusing on the crucial role of the hydrophobic surfactant protein SP-B and SP-C and the ABCA3 protein in alveolar homeostasis. The effects of deficiencies in these proteins on the development of acute and chronic lung disease were discussed. |
Lungs and genetics: RDS and alveolar proteinosis
Mikko Hallman (pdf 98 kb) |
Further insights into pulmonary surfactant function were given by Mikko Hallman, who discussed the geneticbasis of RDS and the multiple factors which interact to produce different lung disease phenotypes. Dr Hallman’s presentation also highlighted the importance of the hydrophilic surfactant proteins SP-A and SP-D in the innatedefence mechanism against respiratory pathogens, and the impact of genetic polymorphisms on susceptibility to infection. |
Respiratory support and outcomes in preterm infants
Ulrich H. Thome (pdf 64 kb) |
Mechanical ventilation (MV) came under scrutiny as it can be associated with significant lung damage in preterm infants. The presentation from Ulrich Thome compared the risks of different MV strategies in exacerbating pulmonary injury in preterm infants. Data suggest that the use of low tidal volumes and increased respiratory rate is preferable, but also that MV should only be employed when strictly necessary. Importantly, there may be significant differences in outcome with different strategies, depending on individual patients’ baseline lung health, and thus no single strategy can be considered optimal. |
Surfactant kinetics in ventilated infants
Virgilio P. Carnielli (pdf 63 kb)
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The kinetics of pulmonary surfactant in ventilated infants were the subject of a presentation by Virgilio Carnielli, who discussed data on the synthesis and kinetics of endogenous surfactant in relation to several clinical conditions, and on the effects of dosing and disease on the pharmacokinetics of exogenous surfactant.
Interestingly, administration of a higher dose of exogenous surfactant (200 mg/kg) to preterm infants with RDS produced a significantly longer DSPC half-life compared to a lower dose (100 mg/kg). Furthermore, a trend towards reduced DSPC pool size in preterm infants who failed extubation, compared with infants who were successfully extubated, was observed in a preliminary study.
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Latest insights into the pathogenesis of bronchopulmonary dysplasia
Christian P. Speer (pdf 69 kb)
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In the final presentation, Christian Speer described a new form of BPD identified among 'low-risk' preterm neonates having little or no initial lung disease. New BPD is characterised by reduced fibrosis, impaired alveolisation and impaired capillary development and there are multiple pre- and postnatal events contributing to its development in preterm infants. |
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