To the Editor: Dr Guinn and colleagues1 found that multiple courses of antenatal corticosteroids
did not produce significant change in the rate of respiratory distress syndrome
(RDS) Hyaline membranes in the lungs of premature infants consist primarily
of fibrin. During embryonic development there is minimal plasminogen produced
except in the last weeks of pregnancy, and normal adult levels are reached
only 7 months postpartum. Thus in premature infants the fibrinolysin system
is inadequate to dissolve hyaline membranes.2
For this reason we have treated a series of 500 premature infants with plasminogen
or placebo postpartum, and demonstrated significant prevention of RDS.3 Those still developing RDS were given intravenous
and aerosolized plasmin, resulting in significant reduction of mortality,
without significant side effects. Four-year followup4
did not find important long range effects in contrast to the findings of Guinn
et al. It appears that plasminogen (fibrinolytic), surfactant, and single-course
corticosteroid therapy should be explored alone and in combination.
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