Surfactant can be supplemented before the neonate needs it.

Abstract

Pulmonary surfactant is a complex mixture, but clearly has one main component, dipalmitoylphosphatidylcholine, or DPPC. The respiratory distress syndrome, RDS, a condition afflicting the baby born too early, is caused by a deficiency of pulmonary surfactant. When this was first realized, attempts were made to treat the condition by supplying DPPC, the main component of the missing surfactant. These first attempts to supplement the pulmonary surfactant were unsuccessful, however, and with the bubble surfactometer, it is clearly seen that DPPC alone does not have the needed surface properties. The adsorption rate is too low, i.e., DPPC only is very slow in forming a film at the air-liquid interface. Natural surfactant on the other hand has the capacity to form a film instantaneously. Therefore, if natural surfactant is supplied in the upper airways prior to the first breath, it will immediately upgrade the maturity of the neonate's lungs; aeration is facilitated and the lungs are given stability. With a surfactant preparation, consisting of the lipids extracted from calf lung lavage, a randomized clinical trial was carried out on infants at particularly high risk of developing RDS. Of the 39 infants receiving surfactant prior to the first breath after birth, only one died neonatally; whereas, of the 33 controls, six died.