EXOGENOUS SURFACTANTS OF NATURAL ORIGIN IN THE TREATMENT OF RESPIRATORY DISTRESS SYNDROME - COMPARATIVE COMPOSITION, BIOPHYSICAL PROPERTIES AND CLINICAL EFFECTIVENESS

Abstract

Respiratory distress syndrome (RDS) remains an important cause of morbidity and mortality in premature infants in Ukraine and around the world. Since the determination of surfactant deficiency as the main cause of this disease, significant progress has been made in studying the structure and function of the pulmonary surfactant system, as well as the possibilities of creating and effective use of exogenous surfactant preparations. Unprecedented long-term fundamental, experimental and clinical studies have ensured the clinical availability of numerous exogenous surfactant preparations, the use of which is currently considered one of the standards of neonatal care, regardless of the level of development of the country. However, all these surfactants are not alike. Although all surfactants licensed for clinical practice significantly reduce mortality in preterm infants from RDS, they differ in phospholipid and protein composition, phospholipid concentration, biophysical properties, dosage, possibilities of less invasive administration, applicability, and clinical efficacy. Comparative clinical studies have shown the benefits of poractant-α, which can be administered at a dose that provides more phospholipids in a smaller volume, contains more surfactant-specific proteins (primarily SPB), and is licensed for administration by the less invasive method. The developers of third-generation synthetic surfactants, which have already demonstrated their clinical effectiveness, place their main hopes on the imitation of these properties. This review presents current data on the structure, composition, and biophysical properties of pulmonary surfactant, provides a comparative description of the most commonly used preparations of exogenous surfactant of animal origin, and characterizes additional prerequisites for the effective use of surfactant therapy.