Clinical experience with exogenous natural surfactant

Area of Science:

• Neonatal Medicine
• Pulmonology
• Biochemistry

Background:

• Respiratory distress syndrome (RDS) is a common and serious condition in preterm infants.
• Natural surfactant replacement therapy has emerged as a critical intervention for managing RDS.
• Over 600 preterm infants have participated in randomized controlled trials evaluating natural surfactants.

Purpose of the Study:

• To evaluate the efficacy and safety of natural surfactant replacement therapy in preventing and treating respiratory distress syndrome in preterm neonates.
• To analyze outcomes from prophylaxis and rescue studies involving natural surfactant administration.
• To identify potential side effects and areas for future research in surfactant therapy.

Main Methods:

• Randomized controlled trials (RCTs) involving over 600 preterm infants.
• Administration of four types of natural surfactant (animal lung or human amniotic fluid derived) via intratracheal instillation.
• Two trial designs: prophylaxis (at birth for <30 weeks gestation) and rescue (approx. 5 hours after birth for ill infants).

Main Results:

• Prophylaxis studies showed reduced mortality, pneumothorax, and increased survival without bronchopulmonary dysplasia (BPD).
• Rescue studies demonstrated decreased mortality, pneumothorax, intraventricular hemorrhage, BPD, and improved survival without BPD.
• An increased incidence of patent ductus arteriosus was the only noted side effect.

Conclusions:

• Natural surfactant replacement therapy is effective in improving survival and reducing major morbidities in preterm infants with RDS.
• All tested natural surfactant preparations exhibit similar efficacy, making comparative studies challenging.
• Further research is required to determine optimal surfactant dosage, repeat dosing strategies, and long-term outcomes, especially for less-ill infants.