Surfactants: past, present and future.

Area of Science:

• Neonatal Medicine
• Pulmonary Physiology
• Biochemistry

Background:

• Early experiments by von Neergaard in 1929 suggested pulmonary surfactant's role in the newborn's first breath.
• Research in the 1950s by Pattle, Clements, and Macklin elucidated pulmonary surfactant physiology.
• Avery and Mead's work in the 1960s linked surfactant deficiency to respiratory distress syndrome (RDS) in preterm neonates.

Observation:

• Initial trials of synthetic, protein-free surfactant for RDS were unsuccessful.
• Enhorning, Robertson, Adams, and Fujiwara demonstrated the efficacy of natural surfactants in animal models and preterm infants.
• Numerous trials in the 1980s confirmed surfactant therapy's ability to reduce air leaks and neonatal mortality.

Findings:

• Natural surfactants, containing proteins, are superior to protein-free synthetic surfactants for treating RDS.
• Recent trials compare different natural surfactant preparations, with some evidence suggesting porcine surfactant may be more effective than bovine at specific doses.
• New synthetic surfactants with protein mimics show potential but lack superiority over established natural products and are not yet approved for clinical use.

Implications:

• Surfactant therapy is a cornerstone in managing preterm newborns, significantly improving survival rates.
• Optimal delivery methods, such as rapid bolus administration, are preferred over nebulization, though less invasive techniques show promise.
• Further research is needed to optimize surfactant formulations, delivery, and treatment protocols, especially for other neonatal respiratory disorders and to mitigate risks like chronic lung disease.