(a) Dipalmityl lecithin (DPL): DPL acts as a surfactant and lowers the

surface tension in lung alveoli. The lung alveoli contains 2 types of

cells.

• Type-I: These are thin cells which line the much of alveolar surface,
and

• Type-II: These are granular pneumocytes, round cells and contain

lamellar inclusions. These inclusions contain surfactant, DPL,
which is secreted from these cells by exocytosis.Surface activity
is that phenomenon whereby the surface tension of the air-
alveolar lining interface is lowered with expiration due to
presence of DPL. In absence of normal surface activity, if DPL is
absent, the alveolar radius becomes smaller with expirations, the
wall tension rises and the alveoli collapse. Absence of DPL, in
premature foetus, produces collapse of lung alveoli, which
produce respiratory distress syndrome (hyaline-membrane
disease). (b) Lecithin-Sphingomyelin Ratio (L/S ratio): L/S ratio in
Amniotic fluid has been used for the evaluation of fetal lung
maturity. Prior to 34 weeks gestation, the amniotic fluid lecithin
and sphingomyelin concentrations are approximately equal. After
this time, there is a marked increase in lecithin and L/S ratio
increases to greater than 5 at term.

• A L/S ratio of > 2 or > 5 indicate adequate foetal lung maturity

and suggests that respiratory distress after delivery is not
likely to develop.

• Delivery of a premature low weight fetus, with L/S ratio

approximately 1 or <1, indicate that the infant will probably
develop respiratory distress or hyaline membrane disease.
(c) Estimation of lecithin: Estimation of lecithin phosphorus
in amniotic fluid has been considered to be clinically more
useful. A lecithin phosphorus value of 0.100 mg/100 dl
indicates adequate foetal lung maturity.