Abnormalities in the relative concentrations of the components of surfactant have been implicated in prolonged expiratory apnoea (PEA) and sudden infant death syndrome (SIDS). Controversy has, however, surrounded these findings, as they may be secondary to terminal life events. In this study the physical properties of surfactant were measured in children with recurrent apparent life threatening events (ALTEs), PEA, and SIDS. Bronchial lavage samples were obtained from 21 children with recurrent ALTEs, two SIDS victims, and 26 control patients. Lipid components were immediately elutriated from these samples with liquid chloroform. The physical properties of the extracted surfactant were studied on a Langmuir trough in which the area (A) of the monolayer was cycled continuously as the surface tension (gamma) was measured by the Wilhelmy method using a platinum 'flag'. The investigators performing these tests were unaware of the clinical diagnosis. Twenty one of 23 patients displayed abnormal physical properties while seven of 26 controls displayed similar abnormalities. These abnormalities were partially inverted hysteresis (figure of eight) loops and inverted (anticlockwise) loops that also generally exhibited less hysteresis. Of the 26 controls 20 exhibited a wide hysteresis pattern that cycled in a normal (clockwise) direction. These differences were significantly different. It is concluded that children with recurrent ALTEs have definable abnormalities in the physical properties of surfactant and that these findings may provide a sensitive means of identifying those at risk of recurrent ALTEs and SIDS.
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