Multiple Utilization of Surfactant in Neonatology

Abstract

Surfactant replacement therapy for the treatment of respiratory distress syndrome (RDS) and other respiratory diseases in newborns has become one of the most active research areas in neonatology. This research has resulted in improved survival for preterm babies since becoming a routine treatment in the 1990s. The main characteristics of pulmonary surfactant, including its composition, pool, metabolism, inactivation and immediate effects after administration, are well-established. However, some doubts still remain about the use of exogenous surfactants and must be addressed. The new generation of synthetic surfactants has raised questions regarding the choice of surfactant type, the ideal timing for treatment (prophylactic vs early rescue strategy), the adequate dose and number of doses, new administration routes and the effects of the association between the use of antenatal steroids and the surfactant replacement therapy. There is also controversy surrounding the choice between early surfactant administration and the use of a nasal CPAP as an initial strategy to treat RDS and to reduce bronchopulmonary dysplasia (BPD). This article reviews basic and clinical aspects of surfactant replacement therapy for RDS and other respiratory diseases in newborns. Keywords: Surfactant, respiratory distress syndrome, antenatal steroids, mechanical ventilation, newborn, respiratory insufficiency, bronchopulmonary dysplasia, Alveolar edema, atelectasis/hyperdistention, alveolar expansion