Automated image analysis of alveolar expansion patterns in immature newborn rabbits treated with natural or artificial surfactant.

Automated image analysis of histological lung sections was used to compare the efficacy of an artificial surfactant (dipalmitoylphosphatidylcholine + high-density lipoprotein, 10:1) and a natural surfactant (the phospholipid fraction of porcine surfactant, isolated by liquid-gel chromatography in ventilated immature newborn rabbits delivered after 27 days' gestation. Tidal volumes were significantly improved in each group treated with surfactant when compared with controls, but natural surfactant-treated rabbits had significantly higher tidal volumes than those receiving artificial surfactant. There were no statistically significant differences in alveolar expansion between the artificial surfactant group and the controls, but alveolar volume density and a shape factor (assessing the 'circularity' of terminal airspaces) were significantly higher in animals receiving natural surfactant. These animals also had a lower coefficient of variation of alveolar volume density and a lower alveolar average integral mean surface curvature, indicating a uniform pattern of alveoli with a smooth profile. We conclude that automated image analysis is useful for the quantitation of alveolar expansion patterns in immature neonatal lungs and that natural surfactant is superior to the artificial surfactant tested in the present study.