Exogenous surfactant therapy in 2013: what is next? who, when and how should we treat newborn infants in the future?

Abstract

BackgroundSurfactant therapy is one of the few treatments that have dramatically changed clinical practice in neonatology. In addition to respiratory distress syndrome (RDS), surfactant deficiency is observed in many other clinical situations in term and preterm infants, raising several questions regarding the use of surfactant therapy.ObjectivesThis review focuses on several points of interest, including some controversial or confusing topics being faced by clinicians together with emerging or innovative concepts and techniques, according to the state of the art and the published literature as of 2013. Surfactant therapy has primarily focused on RDS in the preterm newborn. However, whether this treatment would be of benefit to a more heterogeneous population of infants with lung diseases other than RDS needs to be determined. Early trials have highlighted the benefits of prophylactic surfactant administration to newborns judged to be at risk of developing RDS. In preterm newborns that have undergone prenatal lung maturation with steroids and early treatment with continuous positive airway pressure (CPAP), the criteria for surfactant administration, including the optimal time and the severity of RDS, are still under discussion. Tracheal intubation is no longer systematically done for surfactant administration to newborns. Alternative modes of surfactant administration, including minimally-invasive and aerosolized delivery, could thus allow this treatment to be used in cases of RDS in unstable preterm newborns, in whom the tracheal intubation procedure still poses an ethical and medical challenge.ConclusionThe optimization of the uses and methods of surfactant administration will be one of the most important challenges in neonatal intensive care in the years to come.

Predictors of mortality and morbidity in extremely low birth weight neonates

“…Infants were not offered intensive care due to limited resources, either because of lack of bed availability or inadequate parental finances. Their unit protocols included most of the newer evidenced-based therapies for this population, including early CPAP, rescue surfactant, and early trophic feedings [2,3].…”

Morbidity and mortality pattern of very low birth weight and extremely low birth weight neonates in a tertiary care hospital

“…Prophylactic use in infants younger than 28 weeks gestation has been shown to decrease short term ventilatory needs but no decrease in incidence of chronic lung disease (BPD) has been proven. 3 The incidence of RDS in preterm infants has been significantly reduced with the use of antenatal steroids that promote lung maturity. The use of antenatal steroids has also been linked to a reduction in the incidence of clinically significant patent ductus arteriosus (PDA) and severe intra ventricular haemorrhage (IVH).…”

The Role of Surfactant Therapy in Nonrespiratory Distress Syndrome Conditions in Neonates

“…Although we found a more recent paper (2013) discussing "exogenous surfactant therapy," it focused primarily on the appropriate timing and methods of administration of surfactant for RDS in preterm infants. 8 Furthermore, although non-RDS conditions were included, the emphasis of the review was not a critical evaluation of the current evidence addressing the use of surfactant for these conditions, but rather, a general overview of potential applications of surfactant therapy outside of RDS. 8 This review presents the evidence and indications for surfactant replacement therapy reported in the literature for non-RDS conditions in the human neonate, focusing primarily on reports published within the last 5 years.…”