Continuous intrapulmonary distension with perfluorocarbon accelerates neonatal (but not adult) lung growth

Nobuhara, Kerilyn K; Fauza, Dario O; DiFiore, John W; Hines, Michael H; Fackler, James C; Slavin, Richard; Hirschl, Ronald; Wilson, Jay M

« Previous Next »Journal of Pediatric Surgery
Volume 33, Issue 2 , Pages 292-298, February 1998

Continuous intrapulmonary distension with perfluorocarbon accelerates neonatal (but not adult) lung growth☆☆☆

Kerilyn K Nobuhara
- Department of Surgery, Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
Dario O Fauza
- Department of Surgery, Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
John W DiFiore
- Department of Surgery, Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
Michael H Hines
- Department of Surgery, Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
James C Fackler
- Department of Surgery, Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
Richard Slavin
- Department of Surgery, Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
Ronald Hirschl
- Department of Surgery, Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
Jay M Wilson
- Address reprint requests to Jay M. Wilson, MD, Children's Hospital, 300 Longwood Ave, Fegan 3, Boston, MA 02115.
- Department of Surgery, Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.

Abstract

Background/Purpose: We have previously demonstrated that experimental fetal tracheal ligation reverses the structural and physiological effects of pulmonary hypoplasia associated with congenital diaphragmatic hernia. The purpose of this study was to determine if lung growth could be similarly accelerated postnatally by continuous liquid-based intrapulmonary distension.

Methods: Ten neonatal lambs were divided into two experimental groups. Five neonatal animals underwent a right thoracotomy with isolation of the anterior superior segment of the right upper lobe. A pressure monitoring catheter was introduced and perfluorocarbon (PFC) was instilled into the segment. Animals were subjected to a 21-day distention period with continuous maintenance of 7 to 10 mm Hg intrabronchial pressure. Five other neonatal animals used as age- and weight-matched controls were killed immediately after distension with PFC to 7 to 10 mm Hg. To evaluate the effect of age on postnatal growth, identical procedures were performed on seven mature sheep. Four adult animals underwent a 21-day distension with PFC, and three animals were killed immediately after PFC distension.

Results: Neonatal animals who underwent distension showed a significant acceleration of lung growth based on right upper lobe volume to body weight ratio (P = .0019), total alveolar number (P = .003), and total alveolar surface area (P = .006), when compared with controls. Alveolar growth was attributed to an increased alveolar number rather than increased alveolar size based on a normal histological appearance, normal airspace fraction (P = NS), and normal alveolar numerical density (P = NS). In contrast, no significant differences in lung growth or maturation indices were present in adult animals.

Conclusions: From this preliminary data we conclude: (1) Liquid-based airway distension does accelerate postnatal lung growth, (2) lung architecture remains normal during this period of accelerated growth, (3) adult sheep do not respond to liquid-based airway distension with lung growth, and (4) prolonged exposure to intrapulmonary PFC appears to be safe. We speculate that stretch is the stimulus for lung growth because there are no known growth factors present in PFC.

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