Metabolism of endogenous surfactant in premature baboons and effect of prenatal corticosteroids

We studied the synthesis of surfactant and the effect of prenatal betamethasone treatment in vivo in very preterm baboons. Ten pregnant baboons were randomized to receive either betamethasone (beta) or saline (control) 48 and 24 h before preterm delivery. The newborn baboons were intubated, treated with surfactant, and ventilated for 6 d. They received a 24-h infusion with the stable isotope [U-¹³C]glucose as precursor for the synthesis of palmitic acid in surfactant phosphatidylcholine (PC). Palmitic acid in surfactant PC became enriched 27 ± 2 h after the start of the isotope infusion and was maximally enriched at 100 ± 4 h. The fractional synthesis rate of PC palmitate in the beta group (1.5 ± 0.2%/d) was increased by 129% above control (0.7 ± 0.1%/d) (p < 0.02, Mann-Whitney U test). The absolute synthesis rate of PC in the beta group [1.6 ± 0.3 μmol/kg/d] was increased by 128% above controls [0.7 ± 0.2 μmol/kg/d] (p < 0.02). These data show that the synthesis of endogenous surfactant from plasma glucose as precursor is a slow process. It is shown, for the first time in vivo, that prenatal glucocorticosteroids stimulate the synthesis of surfactant PC in the very premature baboon.