Remarkably delayed occurrence of normal surfactant composition in an extremely preterm infant.

Reported herein is the first case of a remarkably delayed occurrence of normal surfactant composition in an extremely preterm infant who required a total of 15 doses of artificial pulmonary surfactant (Surfacten (R)). A male infant, born at 26 weeks gestation, developed respiratory distress at birth. Chest radiography was consistent with respiratory distress syndrome. The infant required repeated doses of surfactant, each resulting in transient periods of decreased ventilator requirement and improved blood gas values. Surfactant proteins (SP)-A, SP-B, SP-C, and SP-D from tracheal aspirate samples were analyzed on the 13th day (deterioration period) and 36th day (recovery period) after birth. On the 13th day sufficient SP-A and SP-D but no SP-B no SP-C were detected on western blot analysis. SP-B and SP-C were eventually detected on the 36th day. This infant therefore required almost 3 months to achieve normal surfactant function.