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Neonatology pp 995–1006Cite as

Lung Diseases: Surfactant Replacement Therapy in Newborns

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Abstract

In the past three decades, introduction of prenatal steroid treatment, postnatal surfactant therapy, and assisted ventilation has contributed to better outcomes for neonates with respiratory distress syndrome (RDS). Improved survival is directly related to more effective prevention or treatment of the disease. RDS is caused by surfactant insufficiency leading to alveolar collapse and increased work of breathing with consequent hypoxia, respiratory failure, and mixed respiratory and metabolic acidosis. Following unsuccessful clinical trials in the 1960s with nebulized synthetic surfactants, comprised of phospholipids without surfactant proteins, a number of randomized controlled trials in the 1980s demonstrated benefits of surfactant instilled directly into the lungs of preterm infants. Currently, because of increased use of prenatal steroids and early CPAP, it is clear that early selective use of surfactant is superior to routine prophylactic treatment. However, there are still some occasions when surfactant should be administered in the delivery room including cases when intubation of very preterm infants is needed for stabilization.

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References

  • Ardell S, Pfister RH, Soll R (2015) Animal derived surfactant extract versus protein free synthetic surfactant for the prevention and treatment of respiratory distress syndrome. Cochrane Database Syst Rev 8:000144

    Google Scholar 

  • Avery ME, Mead J (1959) Surface properties in relation to atelectasis and hyaline membrane disease. Am J Dis Child 97:517–523

    CAS  Google Scholar 

  • Aziz A, Ohlsson A (2012) Surfactant for pulmonary hemorrhage in neonates. Cochrane Database Syst Rev 7, CD005254

    Google Scholar 

  • Bahadue FL, Soll R (2012) Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev 11, CD001456

    PubMed  Google Scholar 

  • Ballard RA, Keller RL, Black DM et al (2016) Randomized trial of late surfactant treatment in ventilated preterm infants receiving inhaled nitric oxide. J Pediatr 168:23–29.e4

    Article  CAS  Google Scholar 

  • Berggren P, Liljedahl M, Winbladh B et al (2000) Pilot study of nebulized surfactant therapy for neonatal respiratory distress syndrome. Acta Paediatr 89:460–464

    Article  CAS  Google Scholar 

  • Bloom BT, Clark RH (2005) Comparison of Infasurf (calfactant) and Survanta (beractant) in the prevention and treatment of respiratory distress syndrome. Pediatrics 116:392–399

    Article  Google Scholar 

  • Bohlin K, Jonsson B, Gustafsson AS et al (2008) Continuous positive airway pressure and surfactant. Neonatology 93:309–315

    Article  Google Scholar 

  • Bozdag S, Dilli D, Gokmen T et al (2015) Comparison of two natural surfactants for pulmonary hemorrhage in very low-birth-weight infants: a randomized controlled trial. Am J Perinatol 32:211–218

    Article  Google Scholar 

  • Choi HJ, Hahn S, Lee J et al (2012) Surfactant lavage therapy for meconium aspiration syndrome: a systematic review and meta-analysis. Neonatology 101:183–191

    Article  Google Scholar 

  • Cogo PE, Simonato M, Danhaive O et al (2013) Impaired surfactant protein B synthesis in infants with congenital diaphragmatic hernia. Eur Respir J 41:677–682

    Article  CAS  Google Scholar 

  • Curstedt T, Johansson J (2006) New synthetic surfactants–how and when? Biol Neonate 89:336–339

    Article  Google Scholar 

  • Curstedt T, Halliday HL, Speer CP (2015) A unique story in neonatal research: the development of a porcine surfactant. Neonatology 107:321–329

    Article  Google Scholar 

  • Dani C, Bertini G, Pezzati M et al (2004) Early extubation and nasal continuous positive airway pressure after surfactant treatment for respiratory distress syndrome among preterm infants 30 weeks’ gestation. Pediatrics 113:e560–e563

    Article  Google Scholar 

  • Dargaville PA, Copnell B, Tingay DG et al (2008) Refining the method of therapeutic lung lavage in meconium aspiration syndrome. Neonatology 94:160–163

    Article  Google Scholar 

  • Davis DJ, Barrington KJ, Fetus and Newborn Committee, Canadian Paediatric Society (2005) Recommendations for neonatal surfactant therapy. Paediatr Child Health 10:109–116 [updated Jan 2015]

    Google Scholar 

  • Doyle LW, Schmidt B, Anderson PJ et al (2014) Reduction in developmental coordination disorder with neonatal caffeine therapy. J Pediatr 165:356–359

    Article  Google Scholar 

  • Dunn MS, Shennan AT, Possmayer F (1990) Single versus multiple- dose surfactant replacement therapy in neonates of 30 to 36 weeks’ gestation with respiratory distress syndrome. Pediatrics 86:567–571

    Google Scholar 

  • El Shahed AI, Dargaville P, Ohlsson A et al (2014) Surfactant for meconium aspiration syndrome in full term and late preterm infants. Cochrane Database Syst Rev 12, CD002054

    Google Scholar 

  • Finer NN, Carlo WA, Walsh MC et al (2010) Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 362:1970–1979

    Article  CAS  Google Scholar 

  • Gortner L, Pohlandt F, Bartmann P et al (1994) High-dose versus low-dose bovine surfactant treatment in very premature infants. Acta Paediatr 83:135–141

    Article  CAS  Google Scholar 

  • Hahn S, Choi HJ, Soll R et al (2013) Lung lavage for meconium aspiration in newborn infants. Cochrane Database Syst Rev 4, CD003486

    Google Scholar 

  • Halliday HL (2003) Respiratory distress syndrome. In: Greenough A, Milner AD (eds) Neonatal respiratory disorders, 2nd edn. Arnold, London, pp 247–271

    Chapter  Google Scholar 

  • Halliday HL (2006) Recent clinical trials of surfactant treatment for neonates. Biol Neonate 89:323–329

    Article  CAS  Google Scholar 

  • Halliday HL, Speer CP (1995) Strategies for surfactant therapy in established neonatal respiratory distress syndrome. In: Robertson B, Taeusch HW (eds) Surfactant therapy for lung disease. Marcell Dekker, New York, pp 443–459

    Google Scholar 

  • Halliday HL, Tarnow-Mordi WO, Corcoran JD et al (1993) Multicentre randomised trial comparing high and low dose surfactant regimens for the treatment of respiratory distress syndrome (the Curosurf 4 trial). Arch Dis Child 69:276–280

    Article  CAS  Google Scholar 

  • Hallman M (1989) Recycling of surfactant: a review of human amniotic fluid as a source of surfactant for treatment of respiratory distress syndrome. Rev Perinat Med 6:197–226

    Google Scholar 

  • Herting E, Gefeller O, Land M et al (2000) Surfactant treatment of neonates with respiratory failure and group B streptococcal infection. Pediatrics 106:957–964

    Article  CAS  Google Scholar 

  • Jobe AH, Michell BR, Gunkel JH (1993) Beneficial effects of the combined use of prenatal corticosteroids and postnatal surfactant on preterm infants. Am J Obstet Gynecol 168:508–513

    Article  CAS  Google Scholar 

  • Kattwinkel J, Bloom BT, Delmore P et al (2000) High- versus low threshold surfactant retreatment for neonatal respiratory distress syndrome. Pediatrics 106:282–288

    Article  CAS  Google Scholar 

  • Kattwinkel J, Robinson M, Bloom BT et al (2004) Technique for intrapartum administration of surfactant without requirement for an endotracheal tube. J Perinatol 24:360–365

    Article  CAS  Google Scholar 

  • Keiser A, Bhandari V (2016) Surfactant therapy in nonrespiratory distress syndrome conditions in neonates. Am J Perinatol 33:1–8

    Article  Google Scholar 

  • Konishi M, Fujiwara T, Naito T et al (1988) Surfactant replacement therapy in neonatal respiratory distress syndrome. A multicenter randomised clinical trial: comparison of high versus low-dose of Surfactant TA. Eur J Pediatr 147:20–25

    Article  CAS  Google Scholar 

  • Kribs A, Vierzig A, Hunseler C et al (2008) Early surfactant in spontaneously breathing with nCPAP in ELBW infants – a single center four year experience. Acta Paediatr 97:293–298

    Article  Google Scholar 

  • Kribs A, Roll C, Gopel W et al (2015) Nonintubated surfactant application vs conventional therapy in extremely preterm infants: a randomized clinical trial. JAMA Pediatr 169:723–730

    Article  Google Scholar 

  • Lotze A, Mitchell BR, Bulas DJ et al (1998) Multicenter study of surfactant (beractant) use in the treatment of term infants with severe respiratory failure. J Pediatr 132:40–47

    Article  CAS  Google Scholar 

  • Merrill JD, Ballard PL, Courtney SE et al (2011) Pilot trial of late booster doses of surfactant for ventilated premature infants. J Perinatol 31:599–606

    Article  CAS  Google Scholar 

  • Morley CJ (1991) Surfactant treatment of premature babies: a review of clinical trials. Arch Dis Child 66:445–450

    Article  CAS  Google Scholar 

  • Morley CJ, Davis PG, Doyle LW et al (2008) Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med 358:700–708

    Article  CAS  Google Scholar 

  • Moya F, Gadzinowski J, Bancalari E et al (2005) A multicenter, randomized, masked, comparison trial of lucinactant, colfosceril palmitate, and beractant for the prevention of respiratory distress syndrome in very preterm infants. Pediatrics 115:1018–1029

    Article  Google Scholar 

  • Pandit PB, Dunn MS, Kelly EN et al (1995) Surfactant replacement in neonates with early chronic lung disease. Pediatrics 95:851–854

    CAS  PubMed  Google Scholar 

  • Pfister RH, Soll RF, Wiswell T (2007) Protein containing synthetic surfactant versus animal derived surfactant extract for the prevention and treatment of respiratory distress syndrome. Cochrane Database Syst Rev 4, CD006069

    Google Scholar 

  • Pfister RH, Soll R, Wiswell TE (2009) Protein-containing synthetic surfactant versus protein-free synthetic surfactant for the prevention and treatment of respiratory distress syndrome. Cochrane Database Syst Rev 4, CD006180

    Google Scholar 

  • Pillow JJ, Minocchieri S (2012) Innovation in surfactant therapy II: surfactant administration by aerosolization. Neonatology 101:337–344

    Article  CAS  Google Scholar 

  • Polin RA, Carlo WA, Committee on Fetus and Newborn (2014) Surfactant-replacement therapy for preterm and term neonates with respiratory distress. Pediatrics 133:156–163

    Article  Google Scholar 

  • Ramanathan R, Rasmussen MR, Gerstmann DR et al (2004) A randomized, multicenter masked comparison trial of poractant alfa (Curosurf) versus beractant (Survanta) in the treatment of respiratory distress syndrome in preterm infants. Am J Perinatol 21:109–119

    Article  Google Scholar 

  • Roberts D, Dalziel S (2006) Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 3, CD004454

    Google Scholar 

  • Robertson B, Halliday H (1998) Principles of surfactant replacement. Biochim Biophys Acta 1408:346–361

    Article  CAS  Google Scholar 

  • Rojas-Reyes MX, Morley CJ, Soll R (2012) Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 3, CD000510

    Google Scholar 

  • Sandri F, Plavka R, Ancora G et al (2010) Prophylactic or early selective surfactant combined with nCPAP in very preterm infants. Pediatrics 125:e1402–e1409

    Article  Google Scholar 

  • Schmidt B, Roberts R, Davis P et al (2006) Caffeine therapy for apnea of prematurity. N Engl J Med 354:2112–2121

    Article  CAS  Google Scholar 

  • Schmidt B, Roberts RS, Davis P et al (2007) Long-term effects of caffeine therapy for apnea of prematurity. N Engl J Med 357:1893–1902

    Article  CAS  Google Scholar 

  • Seger N, Soll R (2009) Animal derived surfactant extract for treatment of respiratory distress syndrome. Cochrane Database Syst Rev 2, CD007836

    Google Scholar 

  • Singh N, Halliday HL, Stevens TP et al (2015) Comparison of animal-derived surfactants for the prevention and treatment of respiratory distress syndrome in preterm infants. Cochrane Database Syst Rev 12, CD010249

    Google Scholar 

  • Sinha S, Lacaze-Masmoneil T, Valls-i-Soler A et al (2005) A randomized, controlled trial of lucinactant versus poractant alfa in very premature infants at high risk for respiratory distress syndrome. Pediatrics 115:1030–1038

    Article  Google Scholar 

  • Soll RF (2000a) Prophylactic natural surfactant extract for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2, CD000511

    Google Scholar 

  • Soll RF (2000b) Synthetic surfactant for respiratory distress syndrome in preterm infants. Cochrane Database Syst Rev 2, CD001149

    Google Scholar 

  • Soll R, Ozek E (2009) Multiple versus single doses of exogenous surfactant for the prevention or treatment of neonatal respiratory distress syndrome. Cochrane Database Syst Rev 1, CD000141

    Google Scholar 

  • Soll R, Ozek E (2010) Prophylactic protein free synthetic surfactant for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 1, CD001079

    Google Scholar 

  • Speer CP, Robertson B, Curstedt T et al (1992) Randomized European multicenter trial of surfactant replacement therapy for severe neonatal respiratory distress syndrome: single versus multiple doses of Curosurf. Pediatrics 89:13–20

    CAS  PubMed  Google Scholar 

  • Speer CP, Sweet DG, Halliday HL (2013) Surfactant therapy: past, present and future. Early Hum Devel 89(Suppl 1):S22–S24

    Article  CAS  Google Scholar 

  • Stevens TP, Harrington EW, Blennow M, Soll R (2007) Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Syst Rev 4, CD003063

    Google Scholar 

  • Sweet DG, Carnielli V, Greisen G et al (2013) European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants – 2013 update. Neonatology 103:353–368

    Article  Google Scholar 

  • Trevisanuto D, Grazzina N, Ferrasse P et al (2005) Laryngeal mask airway used as a delivery conduit for the administration of surfactant to preterm infants with respiratory distress syndrome. Biol Neonate 87:217–220

    Article  CAS  Google Scholar 

  • Ueda T, Ikegami M, Rider ED et al (1994) Distribution of surfactant and ventilation in surfactant-treated preterm lambs. J Appl Physiol 76:45–55

    Article  CAS  Google Scholar 

  • Valls-i-Soler A, Fernandez-Ruanova B, Lopez-Heredia J et al (1998) A randomized comparison of surfactant dosing via a dual-lumen endotracheal tube in respiratory distress syndrome. Pediatrics 101, E4

    Article  CAS  Google Scholar 

  • Vento M, Cheung P-Y, Aguar M (2009) The first golden minutes of the extremely-low-gestational-age neonate: a gentle approach. Neonatology 95:286–298

    Article  Google Scholar 

  • Verder H, Albertsen P, Ebbesen F et al (1999) Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks’ gestation. Pediatrics 103, e24

    Article  CAS  Google Scholar 

  • Walsh BK, Daigle B, DiBlasi RM et al (2013) AARC clinical practice guideline. Surfactant replacement therapy: 2013. Respir Care 58:367–375

    Article  Google Scholar 

  • Yeh TF, Lin HC, Chang CH et al (2008) Early intratracheal instillation of budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants: a pilot study. Pediatrics 121:e1310–e1318

    Article  Google Scholar 

  • Yeh TF, Chen CM, Wu SY et al (2016) Intratracheal administration of budesonide/surfactant to prevent bronchopulmonary dysplasia. Am J Respir Crit Care Med 193:86–95

    Article  CAS  Google Scholar 

  • Zani A, Eaton S, Puri P et al (2016) International survey on the management of congenital diaphragmatic hernia. Eur J Pediatr Surg 26:38–46

    Google Scholar 

  • Zola EM, Gunkel JH, Chan RK et al (1993) Comparison of three dosing procedures for administration of bovine surfactant to neonates with respiratory distress syndrome. J Pediatr 122:453–459

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Formerly Regional Neonatal Unit, Royal Maternity Hospital, Belfast, UK

    Henry L. Halliday

  2. Formerly Department of Child Health, Queen’s University Belfast, Belfast, UK

    Henry L. Halliday

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  1. Henry L. Halliday
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Correspondence to Henry L. Halliday .

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Editors and Affiliations

  1. Department of Pediatrics Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy

    Giuseppe Buonocore

  2. Department of Pediatrics Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy

    Rodolfo Bracci

  3. Liverpool Women’s Hospital Neonatal Unit, Liverpool, UK

    Michael Weindling

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Halliday, H.L. (2018). Lung Diseases: Surfactant Replacement Therapy in Newborns. In: Buonocore, G., Bracci, R., Weindling, M. (eds) Neonatology. Springer, Cham. https://doi.org/10.1007/978-3-319-29489-6_210

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  • DOI: https://doi.org/10.1007/978-3-319-29489-6_210

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