Syndrome Infants Research Articles

Incidence and Pathological Patterns of Nephrotic Syndrome among Infants and Children: A Systematic Review.

Nephrotic syndrome (NS) is known to be a prevalent chronic illness in young patients. Periorbital swelling in children with this condition is a recurring symptom, either with or without generalized edema.The current study aimedto examine the incidence and pattern of nephrotic syndrome in infants and children by thoroughly examining the recently available literature. A thorough search of PubMed, SCOPUS, Web of Science, Science Direct, and Google Scholar was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model, to find pertinent material. The Rayyan software (Qatar Computing Research Institute, Ar-Rayyan, Qatar) was utilized during the whole process. Data from a total of 1418 patients from nine trials were considered in this study. Numerous factors influenced the incidence, mean age, sex dominance, and histological patterns in various sample groups. The current findings conclude that variations in socioeconomic, regional, and genetic factors influence the development and pattern of these diseases. The prevalence of pediatric renal disorders differs throughout countries. Season of occurrence, response to corticosteroid treatment, and histopathologic findings appear to differ amongst the diagnosed cases.

Comparison of efficacy between beractant and poractant alfa in respiratory distress syndrome among preterm infants (28-33+6 weeks gestational age) using the less invasive surfactant administration (LISA) technique: A randomized controlled trial.

Exogenous surfactant therapy is vital in managing respiratory distress syndrome (RDS) in preterm infants, with less invasive surfactant administration (LISA) gaining popularity. This study aimed to assess the efficacy and short-term outcomes of LISA using beractant and poractant alfa. In a randomized controlled trial, we enrolled preterm infants (28-33+6 weeks) with RDS requiring surfactant. LISA was employed, with beractant at 100 mg/kg or poractant-alfa at 200 mg/kg. Primary outcome was the need for intubation within 72 hours. Among 120 infants, 3.3% in both groups required intubation within 72 hours (p value 1.00, 95% CI 0.14-6.86). No significant differences in secondary outcomes were noted. However, beractant was significantly more economical than poractant-alfa, with a significantly lower surfactant cost and total care cost for infant hospital stays. Beractant and poractant-alfa exhibit similar efficacy in LISA for preterm infants with RDS. Economic considerations, especially in LMICs, favour beractant. CLINICAL TRIAL REGISTATION: (CTRI/2023/03/050375).

Evaluating Gabapentin Dosing, Efficacy and Safety in Infants

OBJECTIVE Gabapentin for management of neuropathic pain, irritability, neonatal abstinence syndrome, rescue sedation, feeding intolerance and visceral hyperalgesia in infants has grown over the past decade. There remains little guidance for indications, initiation, titration and maintenance dosing trends and assessment of outcomes. The primary objective was to describe gabapentin dosing, and the secondary objectives were to identify outcomes to assess efficacy and describe weaning practices. METHODS A retrospective single-center study was performed in infants younger than 1 year who received gabapentin at Boston Children’s Hospital between 2015 and 2021. The primary outcome was indication, initiation and maximum gabapentin dose. Secondary outcomes included mortality, adverse reactions and impact on feeding volumes, weight-for-age Z-scores and face, legs, activity, cry, consolability (FLACC) scores. Descriptive statistics were utilized. RESULTS Sixty-six infants received gabapentin at a mean ± SD age of 5.5 ± 2.7 months (range of 0–11 months). The mean ± SD initiation dose of gabapentin was 8.6 ± 5.4 mg/kg/day with a median interval of 24 hours (8–24 hours). The maximum mean dose was 23.2 ± 14.4 mg/kg/day at a median interval of every 8 hours (8 hours). The most common indications for initiation were irritability, rescue sedation, and visceral hyperalgesia. There was a statistical improvement in weight-for-age Z scores from 24 hours prior to gabapentin initiation to 2 weeks after the maximum dose of gabapentin (−2.23 ± 1.78 to −1.66 ± 1.91, p < 0.001) and a reduction in FLACC scores (2.29 ± 1.64 to 1.52 ± 1.76, p = 0.007) from 24 hours prior to gabapentin initiation to 3 days after the maximum dose of gabapentin. Three patients experienced minor adverse events. CONCLUSIONS Gabapentin was well tolerated in infants. Initial gabapentin dosing of 5 mg/kg/dose every 24 hours appears safe and consistent with other published studies in infants. The improvement in outcomes with few adverse events suggests a beneficial role for gabapentin.

The Tension Between AAP Safe Sleep Guidelines and Infant Sleep.

To understand tension mothers experience when attempting to follow American Academy of Pediatrics safe sleep guidelines and enhancing infant and parental sleep. Surveys and focus groups were conducted from November 2022 and March 2023 with United States-based English-speaking mothers of infants <6 months of age recruited via social media and who reported a nonrecommended sleep position and/or location ≥2 times the prior week. Twenty-five mothers participated in focus groups and surveys. A total of 80% reported holding or rocking their infant to sleep; 76% fed their infant to sleep. Almost all were aware of the ABCs (Alone, Back, Crib) of safe sleep and intended to follow them before delivery. Many felt that ABCs were unrealistic and placed their infants in nonrecommended locations or positions because they perceived them as more comfortable and helping their infant fall and stay asleep. Mothers were more likely to use nonrecommended practices when they were awake or sleeping nearby and believed they could closely monitor their infant. Some questioned whether ABCs were the only way to achieve safe sleep. Some prioritized other safety concerns (eg, fall prevention) over sudden infant death syndrome or sudden unexpected infant death prevention. Mothers expressed confidence about getting their baby to sleep in general but were less confident that they could do this while following guidelines. Despite awareness of the ABCs, mothers regularly engaged in nonrecommended practices with the goal of improving their own and their infant's sleep. Interventions focused on improving infant and parental sleep while maintaining sleep safety are needed.

Higher awakening threshold of preterm infants in prone position may be a risk factor for SIDS.

The supine sleeping position in the prevention of sudden infant death syndrome in preterm infants is poorly understood. We aimed to investigate the effect of sleep posture on cardiorespiratory parameters and movement patterns in preterm infants close to discharge. This observational study included neonates born in 2022 at the University Hospital Schleswig-Holstein, Lübeck, Germany. Motion sensor data, heart rate, respiratory rate and oxygen saturation were recorded for infants with postconceptional age 35-37 weeks during sleep in the prone and supine positions. We recorded data from 50 infants, born at 31 (24-35) weeks of gestation (mean(range)), aged 5.2 ± 3.7 weeks (mean ± SD), of whom 48% were female. Five typical movement patterns were identified. In the prone position, the percentage of calm, regular breathing was higher and active movement was less frequent when compared to the supine position. The percentage of calm irregular breathing, number of apnoeas, bradycardias, desaturations and vital sign changes were not influenced by position. The prone position seems to be associated with a higher arousal threshold. The supine position appears advantageous for escape from life-threatening situations such as sudden infant death syndrome.

Use of surfactant beyond respiratory distress syndrome, what is the evidence?

Surfactant replacement therapy is currently approved by the United States Food and Drug Administration (FDA) for premature infants with respiratory distress syndrome (RDS) caused by surfactant deficiency due to immaturity. There is strong evidence that surfactant decreases mortality and air leak syndromes in premature infants with RDS. However, surfactant is also used "off-label" for respiratory failure beyond classic RDS. This review discusses current evidence for the use of off-label surfactant therapy for (1) term infants with lung disease such as meconium aspiration syndrome (MAS), pneumonia/sepsis, and congenital diaphragmatic hernia (2) premature infants after 72 h for acute respiratory failure, and (3) the use of surfactant lavage. At last, we briefly describe the use of surfactants for drug delivery and the current evidence on evaluating infants for surfactant deficiency.

Characterizing continuous positive airway pressure (CPAP) Belly Syndrome in preterm infants in the neonatal intensive care unit (NICU).

Reproducibly define CPAP Belly Syndrome (CBS) in preterm infants and describe associated demographics, mechanical factors, and outcomes. A retrospective case-control study was conducted in infants <32 weeks gestation in the Stanford Children's NICU from January 1, 2020 to December 31, 2021. CBS was radiographically defined by a pediatric radiologist. Data analysis included descriptive statistics and comparator tests. Analysis included 41 infants with CBS and 69 infants without. CBS was associated with younger gestational age (median 27.7 vs 30 weeks, p < 0.001) and lower birthweight (median 1.00 vs 1.31 kg, p < 0.001). Infants with CBS were more likely to receive bilevel respiratory support and higher positive end expiratory pressure. Infants with CBS took longer to advance enteral feeds (median 10 vs 7 days, p = 0.003) and were exposed to more abdominal radiographs. Future CBS therapies should target small infants, prevent air entry from above, and aim to reduce time to full enteral feeds and radiographic exposure.

Maternal and neonatal outcomes of dichorionic twin pregnancies achieved with assisted reproductive technology: meta-analysis of contemporary data.

Assisted reproductive technology (ART) is commonly used to achieve pregnancy and often results in dichorionic diamniotic (DCDA) twin pregnancies. However, the potential risks of ART on maternal and neonatal outcomes in these pregnancies are not well understood. The objective is to compare the maternal and neonatal outcomes in DCDA twin pregnancies between those achieved through ART and those spontaneously conceived (SC). We carried out a systematic comprehensive search of electronic databases; namely, PubMed, Embase, Scopus, and the Cochrane Library, from inception to March 2023 with a study period of recruitment between 2003 and 2023. We included all studies comparing the maternal and neonatal outcomes of DCDA twin pregnancies between those achieved by ART and those SC. We analyzed data from 18 cohort studies involving 10,485 women with DCDA twin pregnancies. The meta-analysis showed that ART-conceived pregnancies had a significantly higher risk of preeclampsia or gestational hypertension (GH), gestational diabetes mellitus (GDM), placenta previa (PP), placental abruption (PA), postpartum hemorrhage (PPH), and elective and emergency cesarean sections than SC twin pregnancies. The absolute risks of these complications remained relatively low. We also found a slightly higher risk of respiratory distress syndrome (RDS) and congenital malformations in ART-conceived infants compared to the risks in SC infants. Finally, the risk of neonatal intensive care unit (NICU) admissions was significantly higher in ART-conceived infants than in SC infants, but with high heterogeneity. We found associations between DCDA twin pregnancies conceived through ART and increased frequencies of adverse maternal outcomes. However, the absolute risks of these complications remained low, and the benefits of ART for achieving successful pregnancies may well outweigh the potential risks. Additionally, ART-conceived DCDA twin pregnancies may pose higher risks of RDS, congenital malformations and NICU, admissions than SC DCDA twin pregnancies.

Positive Airway Outcomes in Syndromic Pierre Robin Sequence Infants Treated with Mandibular Distraction Osteogenesis: A Single Surgeon’s Experience

Positive Airway Outcomes in Syndromic Pierre Robin Sequence Infants Treated with Mandibular Distraction Osteogenesis: A Single Surgeon’s Experience

Evaluation of the Copy Number Variants and Single-Nucleotide Polymorphisms of ABCA3 in Newborns with Respiratory Distress Syndrome-A Pilot Study.

Background and Objectives: Respiratory distress syndrome (RDS) in preterm infants commonly occurs due to the immaturity-related deficiency of pulmonary surfactant. Beyond prematurity, various environmental and genetic factors can influence the onset and progression of RDS. This study aimed to analyze three single-nucleotide polymorphisms (SNPs) of the ABCA3 gene to assess the ABCA3 gene as a candidate gene for susceptibility to RDS and overall survival in newborns and to evaluate the utility of MLPA in RDS neonatal patients. Materials and Methods: Three SNPs were chosen and genotyped in a cohort of 304 newborns. Data analysis and statistical tests were employed to examine allele frequencies, haplotypes, and measures of pairwise linkage disequilibrium. Results: There was no observed haplotype association with SNPs rs13332514 (c.1059G>A) and rs170447 (c.1741+33T>C) among newborns, both with and without RDS (p > 0.05). The minor C allele frequency of the ABCA3 rs323043 (c.1755G>C) SNP showed a significant increase in preterm infants with RDS. MLPA results indicated that the predominant findings were normal, revealing no CNVs in the genes ABCA3 and SFTPC that were investigated in our patients. Conclusions: The presence of the variant C allele in the rs323043 (c.1755G>C) SNP may be a risk factor for RDS in premature newborns.

Newborn Hospitalizations Before and During COVID-19 Pandemic in Poland: A Comparative Study Based on a National Hospital Registry.

Objectives: There are limited data on the impact of the COVID-19 outbreak in Poland on newborn health. The aim of the study is to show recent information on hospitalizations of newborns in Poland in the pre-pandemic and COVID-19 pandemic era. Methods: A retrospective, population-based study was conducted using data from hospital discharge records of patients hospitalized in 2017-2021. Results: The data on which the study was based consisted of a substantial number of 104,450 hospitalization records. Annual hospitalization rate was estimated to be 50.3-51.9 per 1,000 in 2017-2019, 56 per 1,000 in 2020 and it rose to 77.7 per 1,000 in 2021. In comparison to the pre-pandemic period, in the COVID-19 era, we observed significantly more hospitalization cases of newborns affected by maternal renal and urinary tract diseases (p < 0.001), syndrome of infant of mother with gestational diabetes (p < 0.001), maternal complications of pregnancy (p < 0.001). In the COVID-19 era, the prevalence of COVID-19 among newborns was 4.5 cases per 1,000 newborn hospitalizations. Conclusion: The COVID-19 pandemic outbreak could significantly contribute to qualitative and quantitative changes in hospitalizations among newborns.

A clinical study evaluating the combination of LISA and SNIPPV for the treatment of respiratory distress syndrome in preterm infants

To compare the therapeutic effect of less invasive surfactant administration (LISA) followed by synchronized nasal intermittent positive pressure ventilation (SNIPPV) and traditional intubate-Surfactant-Extubate (InSurE) strategy for the treatment of neonatal respiratory distress syndrome (NRDS). A single-center, non-randomized and single- blinded study Tertiary neonatal intensive care unit 89 infants enrolled were preterm with gestational age < 366/7 weeks and clinically diagnosed with neonatal RDS (NRDS) Interventions: 32 infants were assigned to the LISA + SNIPPV group and 57 infants to the InSurE + nCPAP group. No statistically significant differences were noted in the baseline characteristics of the enrolled infants. A lower proportion of infants developed BPD in the LISA + SNIPPV group compared to the InSurE + CPAP group [10 (31.25%) vs. 21 (36.84%), P > 0.05]; however, there was no statistically significant difference. The number needed to treat (NNT) with LISA + SNIPPV to prevent BPD development is 18. The mortality rate was not significant between our study arms [1 (3.13%) vs 2 (3.51%), P > 0.05]. There were no statistically significant differences in the durations (days) of MV [(12.18 ± 13.89) vs. (11.35 ± 11.61), P > 0.05], oxygen therapy [(35.03 ± 19.13) vs. (39.75 ± 17.91), P > 0.05] and re-intubation rates [(0.19 ± 0.40) vs. (0.21 ± 0.45), P > 0.05] between the two study groups. In terms of complications, the incidence of patent ductus arteriosus (PDA) [24 (75.00%) vs. 27 (47.37%), P < 0.05] was higher and a lower rate of disturbed liver function [1 (3.23%) vs. 19 (33.33%), P < 0.05] were observed in the LISA + SNIPPV group. Acid–base imbalances were reportedly significantly higher in the InSurE group (P < 0.05). No significant differences in other complications were noted. In the interventional group, FiO2 requirements were significantly lower up until the 3rd week of treatment [FiO2 at day 0, (30.75 ± 4.78) vs. (34.66 ± 9.83), P < 0.05; FiO2 at day 21, (25.32 ± 3.74) vs. (29.11 ± 8.17), P < 0.05], as was RSS on days 2 [(0.77 ± 0.38) vs. (1.94 ± 0.75), P < 0.05] and 3 [(0.66 ± 0.33) vs. (1.89 ± 0.82), P < 0.05] after treatment. Additionally, infants in the standard group had a significantly prolonged hospital stay (days) [(45.97 ± 16.93) vs. (54.40 ± 16.26), P < 0.05]. The combination of LISA and SNIPPV for NRDS can potentially lower the rate of BPD, FiO2 demand and shorten the length of hospitalization.

Brain injury following child maltreatment syndrome in newborns and young children. Shaken baby syndrome

Shaken baby syndrome is widely discussed in the literature. This syndrome is considered as a variant of child maltreatment syndrome. In the English-language literature, there are data on high incidence of this syndrome and difficult diagnosis. There are no such diagnosis in the Russian and reports devoted to this issue. To assess the incidence and nature of injuries following child maltreatment/shaken baby syndrome in infants and young children. We analyzed case records of 3668 patients aged 1-36 month between 2017 and 2021 with injury/suspected traumatic brain injury (TBI). Mild TBI was in 47.2% of patients, moderate and severe - in 56.8% of patients. Twenty-eight children admitted with GCS score 3-8. CT was performed in case of risk factors for intracranial injuries (1703 patients). Abnormalities were found in 71.6% of cases. Sixty-four children required surgical treatment. Overall mortality rate was 0.7%. Accidental trauma was found in 3664 cases. We verified child maltreatment/shaken baby syndrome in only 4 (0.1%) cases. At the alleged moment of injury, there were male persons (cohabitant or guardian) with the child that is consistent with literature data. In all 4 cases, we observed severe combined TBI. In one case, brain damage was regarded as a result of chronic trauma. Indeed, MRI diagnosed thrombosis of bridging veins along convexital parts of the frontal, parietal and occipital lobes. There were GOS grade I in 2 patients (death), grade III in 1 patient (severe disability) and grade IV in 1 patient (recovery). Child maltreatment/shaken baby syndrome is less common among infants and young children in the Russian Federation. This may be due to national, cultural and religious traditions. Indeed, infants and children under 3 years of age are cared for by female persons. The mechanism of injury (shaking) leads to typical multiple injuries involving various organs and systems. These damages require multidisciplinary approach to diagnosis and treatment. MRI-confirmed thrombosis of bridging veins may be an additional diagnostic sign indicating the mechanism of injury.

Non-Accidental Injury Involving a Neonate

Non-accidental injury (NAI) was brought forward by the investigation and research that was conducted by Ambroise Tardieu, John Caffey and Henry Kempe. Whiplash-shaken infant syndrome and battered child syndrome are the other alternative terms used. NAI is defined as repetitive physical abuse. Marks of injuries such as multiple bruises or abrasions of differing ages and patterns, bite marks, burns and radiological evidence of old bony fractures are valuable indicators in distinguishing nonaccidental from accidental injuries. In addition, birth trauma, bleeding disorders, sepsis, vasculopathy, congenital anomalies, metabolic abnormalities and true accidental injuries must be ruled out beforehand with a meticulous approach when dealing with such deaths. Here, we report a case of a 28-day-old female neonate who was brought in unresponsive by her parents and was pronounced dead at the accident and emergency department. The external examination did not reveal any gross abnormality whereas, the internal examination revealed subgaleal haematoma, subdural and subarachnoid haemorrhage. The microscopic examination revealed retinal haemorrhage. The cause of death was attributed to blunt force trauma to the head. This case is a reminder to all forensic and clinical pathologists that an extremely uncommon manifestation can occur, therefore, a meticulous approach should always be undertaken, before corroborating a cause of death. In conclusion, the findings of the forensic autopsy and histopathology facilitated the investigation and established the cause of death.

Electrocardiographic Changes with Age in Japanese Patients with Noonan Syndrome.

Little information is available on age-related electrocardiographic changes in patients with Noonan syndrome. This single-center study evaluated the electrocardiograms of patients with Noonan syndrome. We divided the patients (n = 112; electrocardiograms, 256) into four groups according to age: G1 (1 month-1 year), G2 (1-6 years), G3 (6-12 years), and G4 (>12 years). Typical Noonan syndrome-related electrocardiographic features such as left-axis deviation, abnormal Q wave, wide QRS complex, and small R wave in precordial leads were detected. A high percentage of QRS axis abnormalities was found in all groups. Significant differences in right-axis deviation (RAD) were noted among the groups: 56.5% of G1 patients showed RAD compared with 33.3% of G2, 21.1% of G3, and 19.2% of G4 patients. The small R was also significantly different among the groups: 32.6% of G1 patients showed a small R wave compared with 14.9% of G2, 8.5% of G3, and 15.4% of G4 patients. Of the 53 patients with Noonan syndrome aged 1 month to 2 years, 18 had T-positive V1 with a higher prevalence of pulmonary stenosis and cardiac interventions. QRS axis abnormalities, small R in V6, and T-positive V1 could help diagnose Noonan syndrome in infants or young children.

Пренатальні, перинатальні та неонатальні фактори ризику народження дітей з епілептичними енцефалопатіями

The negative impact of perinatal factors on the brain can play a significant role in the etiopathogenesis of epileptic seizures in young children and the development of epileptic encephalopathies (EE). Purpose - to study the characteristics of the course of the prenatal and neonatal periods in young children with EE for the further formation of risk groups of children who need active monitoring. Materials and methods. An analysis of prenatal and neonatal features of anamnesis of 157 children with EE and their mothers was carried out. The children were divided into 3 groups: the Group I - children with EE who had the debut of epileptic seizures before the age of 1 year (n=75); the Group II - children with EE who had the debut of epileptic seizures after the age of 1 year (n=44); the Group III - children with epileptiform and developmental encephalopathies (EDE) (n=38). Results. The course of pregnancy in mothers of children with EDE is characterized by a high frequency of early gestosis, the threat of abortion in the second half of pregnancy and polyhydramnios (28.9%, 31.6%, 23.7%, respectively). Some (31.6%) of children with EDE were born prematurely, 21.1% by emergency caesarean section. Childbirth in mothers of children with EDE was characterised by a pathological course (44.7%), weakness of labor activity and prolonged dehydration (36.8% and 28.9%, respectively), and the birth of a child with distress (21.1%). The course of the neonatal period in children with EDE was characterized by a higher frequency of hypoxic-ischemic encephalopathy (23.7%) than in children with other forms of EE. In children of the Group I, syndromes of motor disorders (20.0%) and muscle hypotonia (17.3%) were more often observed. Conclusions. Aggravating factors of obstetric-gynecological and somatic anamnesis in women, and the course of prenatal and neonatal periods of life, which can act as a basis for the formation of EE and EDE in children, have been established. Among them are preeclampsia, placental pathology, changes in the amount of amniotic fluid during pregnancy, pathological childbirth, central nervous system depression syndrome and convulsive syndrome in infants. The obtained data will contribute to the formation of high-risk groups of children who need active monitoring. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Achenbach Syndrome in a Male Infant with Brown Discoloration of Skin: A Case Report

Achenbach syndrome or paroxysmal hand hematoma is a rare and scantily found medical condition. It is a condition with benign, spontaneous, self-limiting focal hemorrhage under the skin, mostly located in the extremities of upper limb or lower limb, mostly displaying bluish discoloration of skin. Here, a brief communication in the form of case report of 1 year old child from Russian Federation is being presented, which was compatibly diagnosed to be Achenbach syndrome by analyzing the history and other medical reports. The typical nature of the case being presented is that the patient had brown discoloration of skin rather than blue and experienced no pain as reported by guardians of the patient.

Overview of Nephrotic Syndrome in Arab Children: Systematic review

Background: Nephrotic syndrome (NS) is documented as a common chronic disease in childhood. Children with this illness repeatedly show periorbital swelling with or without generalized edema. It was estimated that the annual incidence rate of NS in children aged below 16 years is 2 to 7 new cases per 100 000, with a prevalence rate of 16 cases per 100 000. Objectives: This systematic review comprehensively investigates the recently published literature on incidence and pattern of nephrotic syndrome in infants and children. Methods: PubMed, SCOPUS, Web of Science, Science Direct, and Google Scholar were systematically searched for relevant literature. Rayyan QRCI was employed throughout this comprehensive process. Results &amp; interpretation: This review included nine studies with a total of 1418 patients. The incidence, mean age, sex dominance in different sample groups and the histopathological patterns were differ according to many factors.

Enhancing Airway Strategies in Treacher Collins Syndrome Infants during Primary Facial Cleft Closure

Enhancing Airway Strategies in Treacher Collins Syndrome Infants during Primary Facial Cleft Closure

Role of surfactant in the pathogenesis of bronchopulmonary pathology

Pulmonary surfactant is an important structure of the lungs, providing basic vital functions: reducing alveolar surface tension and facilitating breathing, preventing collapse of the airways and ensuring their patency, protection against infections and pathological environmental factors. Although disturbances of surfactant homeostasis are usually considered in the context of respiratory distress syndrome in preterm infants, it has been established that many lung diseases in adults are accompanied by significant disturbances of surfactant homeostasis. However, preclinical and clinical studies of bronchopulmonary pathology too often overlook the potential role of changes in the qualitative or quantitative composition of pulmonary surfactant in the pathogenesis and development of disease symptoms. In many lung diseases, whether these disturbances in homeostasis are cause or effect remains contravertial field. This review will examine current data on the composition, main functions of pulmonary surfactant and the role of its dysfunction in the pathogenesis of the most frequently encountered bronchopulmonary diseases in the practice of pulmonologists, therapists and rehabilitation specialists, in particular, such as acute respiratory distress syndrome in adults, including associated with a new coronavirus infection, pneumonia of various etiologies and their consequences, bronchial asthma, chronic obstructive pulmonary disease. The review presents the current best practices of replacement therapy with exogenous surfactant preparations and the prospects for pharmacological modulation of surfactant homeostasis disorders in the above nosological forms.