Sequential treatments of premature lambs with an artificial surfactant and natural surfactant.

To test an artificial surfactant in vivo, six 120-d gestational age lambs were treated at birth with a mixture of a 9:1 M ratio of [14C]dipalmitoyl phosphatidylcholine (DPC) and phosphatidylglycerol at a dose of 100 mg DPC/kg. Nine other lambs were not treated. The mean PO2 values of the lambs treated with artificial surfactant were 65.7 +/- 11 mm Hg vs. 24.8 +/- 1.6 mm Hg for the untreated lambs (P less than 0.001). All lambs then were treated with 50 mg/natural surfactant lipid per kg, which promptly improved PO2 in all lambs. The PO2 values of those lambs previously treated with artificial surfactant remained greater than 100 mm Hg for 2.5 +/- 0.5 h vs. 0.9 +/- 0.3 h for lambs untreated with artificial surfactant (P less than 0.01). The pH and PCO2 values were not strikingly different between the two groups of lambs. Airway samples taken from lambs treated with artificial surfactant before treatment with natural surfactant had minimal surface tensions of 32 +/- 2.9 dyn/cm, whereas the artificial surfactant reisolated from these samples by centrifugation had minimum surface tension of 0 dyn/cm. The minimum surface tension of artificial surfactant was inhibited by fetal lung fluid from the premature lambs, whereas the minimum surface tension of natural surfactant was much less sensitive to inhibition. Artificial surfactant did not improve the pressure-volume characteristics of unventilated premature lung, whereas natural surfactant did. The change in specific activity of [14C]DPC following treatment with natural surfactant indicated that approximately 50% of the DPC initially administered was no longer associated with the airways.