Surfactant for Respiratory Distress Syndrome: New Ideas on a Familiar Drug with Innovative Applications

Abstract

In the last 4 decades, advances in neonatology have led to a significant increase in the survival of preterm infants. One of the biggest advances was the introduction of surfactant replacement therapy for the treatment of respiratory distress syndrome. This is the main cause of respiratory insufficiency in preterm infants and is one of the major causes of perinatal morbidity and mortality. Surfactant replacement therapy is already a well-investigated and established therapy in neonatology. However, surfactant replacement therapy has progressed and been refined over recent decades, especially with the increasing care for preterm infants born before 26 weeks' gestational age and the recent clinical focus on avoiding mechanical ventilation. Clinical evidence is evolving on new types of surfactant, surfactant dosages, co-medication given before, with, or after surfactant replacement, and new technical advances regarding the mode of administration.

Comparison Between Less Invasive Surfactant Administration (LISA) and Intubation-Surfactant-Extubation (InSurE) in Preterm Infants with Respiratory Distress Syndrome: A Retrospective Study

“…The authors presumed that the distribution of the surfactant caused these differences. Using animal experiments, Niemarkt reported decreased surfactant distribution to the right upper lobe in the LISA method compared with the intubation method [18]. Surfactant distribution, which is affected by the volume of the administered surfactant, rate of installation, the position of the infant, and underline the status of the lung of the patient, is an essential factor of surfactant administration [19].…”

Less Invasive Surfactant Administration via Thin Catheter in Late Preterm Infants With Respiratory Distress Syndrome

“…The LISA method via thin catheter is widely adapted in Europe [29] and is a recommended method of care according to the latest consensus guidelines [9,12,30]. However, there is still large variability in the application of this technique regarding patient population that may bene t from this approach; the catheter type, the adequate dose and type of surfactant; the use of premedication; and the need of pharmacologic sedation during the procedure [31].…”

A survey on criteria for intubation in moderate to late preterm infants with respiratory distress

“…We appreciated the survey respondents' comments about the use of MIST or LISA prior intubation if patient fails on CPAP support. 18,29,30 We received two comments by the survey responders that they would use a threshold FiO 2 of 30% while on humidified high flow nasal cannula (HHFNC) therapy. Recent surveys have found extensive use of HHFNC in special care nurseries in many parts of the world.…”