The Cow-Lung Concoction

It may save "preemies" from early death

When John and Jacqueline Kennedy lost their newborn son Patrick in 1963, most Americans had never heard of the disorder that took the life of the President's child: hyaline membrane disease (HMD). In fact, the major cause of HMD had been discovered only four years before by a Harvard research team. The disorder is largely confined to prematurely born infants; in the U.S. it strikes 20,000 "preemies" annually, and, despite improved treatment, still kills more than 3,000 of them.

Hyaline membrane disease occurs because the infant's lungs do not produce enough of a vital substance: pulmonary surfactant, a whitish, soaplike chemical that coats the lungs and keeps airspaces open. Without surfactant, the air sacs in the lungs become stiff and collapse, preventing inhalation, and the lungs become dense and hyaline, or glasslike. The usual recourse has been to supply the baby with oxygen-enriched air (sometimes with the aid of a respirator) until the lungs are mature enough to manufacture a sufficient amount of the chemical. But this involves expensive machines and a long hospital stay that can cost more than $20,000.

Now comes what may eventually be a simpler and cheaper solution. In the British medical journal Lancet, Pediatrician Tetsuro Fujiwara reports successfully using a strange concoction to coat the lungs of 15 newborns with HMD who were not responding to standard therapy. The ingredients: purified surfactant taken from cow lungs and organic compounds. Others have tried a similar approach, using totally synthetic surfactants. But such solutions seemed not to work because they lacked some essence of the natural substance. Moreover, no one had yet devised a way to apply a surfactant directly to a baby's lungs.

Fujiwara, an associate professor at the Akita University School of Medicine in northern Japan, solved these problems in a sort of medical hat trick that is, as he puts it, "simplicity itself." Picking up cow lungs at local slaughterhouses, he scraped off their surfactant, rid it of most of its protein, modified it with the organic compounds, and put the resulting white powder into solution. That way, with a tube and syringe, he could propel it directly into an infant's air passages. To spread it over the lungs, he just moved his tiny patients about until the alveolar cells that make up the lining of the lung were all coated. The infants were immediately placed in a 100% oxygen atmosphere and put on respirators to help aerate their lungs. Before long, they were breathing more normally, and within hours, they had turned from deathly gray to a healthy pink.

Some researchers have reacted cautiously to Fujiwara's announcement, warning that any long-range effects of using surfactant substitutes remain to be seen. They point out that scientists have not yet unraveled the chemical structure of natural surfactants and thus cannot tell if there is any significant difference between the human and animal variety. Fujiwara acknowledges that much testing remains to be done before the cow-lung concoction achieves widespread use. He plans a large-scale clinical trial of the substance this summer.

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