Prophylactic Treatment of Very Premature Infants with Human Surfactant

Abstract

We undertook a randomized, controlled trial to determine whether human surfactant administered endotracheally at birth to very premature infants (gestational age, 24 to 29 weeks) would prevent the respiratory distress syndrome or reduce its severity. Thirty-one treated infants (birth weight, 938 +/- 286 g) were compared in a blinded fashion with 29 control infants (birth weight, 964 +/- 174 g). The lecithin/sphingomyelin ratio was less than 2 in all infants, and phosphatidylglycerol was not present in amniotic fluid or tracheal fluids at birth, indicating a deficiency of surfactant in the lungs. The principal dependent variables were neonatal death, the incidence of bronchopulmonary dysplasia, and the infant's requirement for respiratory support (and its complications). The surfactant-treated group had significantly fewer deaths than the control group (16 percent vs. 52 percent, P less than 0.001), fewer cases of bronchopulmonary dysplasia (16 percent vs. 31 percent), and significantly fewer cases of pulmonary interstitial emphysema (P less than 0.001) and pneumothorax (P less than 0.02). Prophylactic treatment with human surfactant also substantially reduced the period of neonatal intensive care. We conclude that treatment with human surfactant offers promise for improving the survival of very premature infants with a surfactant deficiency and for reducing the pulmonary sequelae of the respiratory distress syndrome.

Role of prophylactic surfactant in preterm infants

“…[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] However, in our study, no such decrease in incidence of air leaks was observed. There was a statistically significant difference in the number of babies developing retinopathy of prematurity (any stage) and the number of babies needing laser treatment for retinopathy of prematurity between the two groups (P = 0.01).…”

“…Randomised controlled trials that compare the prophylactic administration of surfactant to control treatment have been carried out using natural surfactant extracts as well as synthetic surfactant preparations. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Although both prophylactic surfactant administration and surfactant treatment of infants with established respiratory distress syndrome are successful treatment strategies, theoretical advantages have been proposed for each strategy. Prophylactic administration offers the theoretical advantage of replacing surfactant before the onset of respiratory insufficiency, decreasing the need for ventilator support and avoiding barotrauma that may result from even short periods of assisted ventilation.…”

“…A systematic review of the eight randomised controlled trials which compared the prophylactic administration of natural surfactant extract to control treatment has shown that prophylactic administration of natural surfactant extract led to a significant reduction in the risk of neonatal mortality (typical relative risk (RR) 0.60, 95% CI 0.44, 0.83; typical risk difference (RD) -0.07, 95% CI -0.12, -0.03). [8][9][10][11][12][13][14][15] Narang et al 29 in an Indian study found that the early neonatal mortality was significantly lower in surfactant (25%) than in the no surfactant group (38.7%). As the number of babies in the surfactant group was small, we could not do a subgroup analysis to decide which babies would benefit the most from this mode of intervention.…”

The Use of Synthetic Peptides in the Formation of Biophysically and Biologically Active Pulmonary Surfactants

“…The importance of these apoproteins, termed SP-B and SP-C (20) in the ability of natural or synthetic surfactants to be able to reduce surface tension at the epithelial air/liquid interface in the lung has been the subject of several recent papers (2,7,10,11,(13)(14)(15)(17)(18)(19)(21)(22)(23). Human surfactant isolated from term amniotic fluid (24)(25)(26), as well as heterologous surfactants consisting of lung mince or airway lavage lipid extracts from calves Sephadex LH-60 (Pharmacia Fine Chemicals, Uppsala, Sweden) column. The column was run at a flow rate of 2.5 mL/h using the acidified chloroform/methanol buffer, and fractions of 0.5 mL were collected.…”

The Evolution of Neonatology

“…It was not until 1980 that Fujiwara reported success in human newborns using exogenous liquid surfactant derived from minced calf lung (91). At that time, others were working on surfactant extracts derived from human amniotic fluid or a synthetic product (92,93); there was also a powdered form of surfactant, with the acronym ALEC, for acute lung expansion compound (94).…”