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Updated: Jul 9, 2025

Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
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Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS

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Timing of surfactant treatment in respiratory distress syndrome

Anton H van Kaam1, Hendrik J Niemarkt2, Wes Onland1

  • 1Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.

Seminars in Fetal & Neonatal Medicine
|November 28, 2023
PubMed

Insights

Early surfactant treatment improves survival for very preterm infants with respiratory distress syndrome (RDS). This review examines how changes in respiratory support and surfactant administration techniques affect this timing benefit.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Critical Care

Background:

  • Exogenous surfactant administration significantly improved survival rates for very preterm infants diagnosed with respiratory distress syndrome (RDS) since the 1980s.
  • Pre-2000 randomized controlled trials established that earlier surfactant treatment correlates with greater survival benefits.
  • Recent decades have seen a paradigm shift in respiratory support for RDS, moving from invasive mechanical ventilation to less invasive methods.

Purpose of the Study:

  • To review the impact of evolving respiratory support strategies on the efficacy of surfactant timing in preterm infants with RDS.
  • To evaluate how newer, less invasive surfactant administration techniques influence the relationship between treatment timing and clinical outcomes.
  • To synthesize current evidence on the effect of practice changes on mortality and morbidity in this vulnerable population.

Main Methods:

  • Systematic review of randomized controlled trials and observational studies.
  • Analysis of data comparing outcomes based on surfactant administration timing.
  • Assessment of the influence of different respiratory support modalities (invasive vs. non-invasive) and surfactant delivery methods.

Main Results:

  • The optimal timing for surfactant administration may be influenced by the mode of respiratory support.
  • Less invasive surfactant administration techniques might alter the benefits of early treatment compared to historical data.
  • Evidence synthesis is ongoing to precisely quantify the impact of these changes on RDS outcomes.

Conclusions:

  • The established benefit of early surfactant treatment in RDS may be modified by current respiratory support and delivery practices.
  • Further research is needed to refine optimal surfactant timing strategies in the context of modern neonatal respiratory care.
  • Understanding these evolving dynamics is crucial for improving outcomes in very preterm infants with RDS.

Keywords:
Continuous positive airway pressureIntubate-surfactant-extubateLess invasive surfactant treatmentMechanical ventilationPreterm infant

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