Prevention of respiratory distress syndrome

RDS continues to be a major problem for premature infants despite a better understanding of its pathophysiology and of ways to try to prevent it. To date, prenatal administration of glucocorticoids has been the most widely used method of accelerating fetal lung development. However, several limitations of this therapy have prompted the search for alternative approaches. Most efforts have focused on the potential use of combined hormonal therapy with glucocorticoids and either thyroid hormones or TRH. The easy transplacental passage of the latter tends to favor its use. The use of hormonal therapy prenatally and surfactant administration at birth appears currently to be the best approach to prevent RDS. The greatest benefit would clearly come from the prevention of prematurity (Fig 1), but this has not proved to be an easy task.