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Surfactants: past, present and future.

H L Halliday1

  • 1Department of Child Health, Queen's University of Belfast, Belfast, Northern Ireland. h.halliday@qub.ac.uk

Journal of Perinatology : Official Journal of the California Perinatal Association
|June 18, 2008
PubMed
Summary
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Pulmonary surfactant therapy, crucial for preterm infants with respiratory distress syndrome (RDS), has evolved significantly. Natural surfactants are more effective than synthetic ones, with ongoing research into optimal delivery methods and formulations.

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.

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  • 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.