Table 2.
Surfactant therapy for neonates with respiratory distress syndrome.
| Surfactant therapy | Delivery method | Mechanical ventilation | Notes | Ref. |
|---|---|---|---|---|
| Synthetic DPPC | Inhalation | N/A | Inconclusive results and need further investigation | [41] |
| DPPC/DPPG (9:l) | Nebulization | No | Failed trial | [42] |
| A mixture of natural surfactant lipids and synthetic lipids | ETT | Yes | Not randomized | [43] |
| Artificial lung surfactant contains pure DPPC and PG | ETT (dry powder) | CPAP or IPPV after delivery if needed | Substantially less improvement compared with that achieved with animal surfactant extracts or human surfactant | [44] |
| Human surfactant | ETT | Yes | Promising treatment for very premature neonates Surfactant treatment at 2 to 4 h after birth is similar to treatment at birth No neurodevelopmental outcomes throughout the first year |
[27, 29–32,34] |
| BLES® | Tracheal | Manual inflations after delivery | Surfactant therapy, before the first breath, is protective against RDS, negative effects of hypoxia and ventilatory support | [118] |
| BLES | ETT | Yes after delivery | Prevention of RDS in extremely premature infants One dose at birth may not be sufficient Lower incidence of mild CLD with late treatment Significant advantage to the administration of initial dose as prophylaxis rather than as rescue therapy |
[119–123] |
| Exosurf® | ETT | Yes | Rescue use can improve the morbidity and mortality rates Reduced pulmonary vascular resistance, leading to a decrease in pulmonary artery pressure and an increase in ductal flow velocity Beneficial long-term effects. No neurodevelopmental outcome after 1 or 2 year assessment |
[45,70, 124–127] |
| Natural porcine surfactant | Tracheal | N/A | There was immune response after surfactant treatment | [127] |
| Curosurf® | Boluses into the lower trachea | N/A | No difference between high and low dose surfactant regimens for RDS were noted | [128] |
| Dexa- or betamethasone + Survanta® | N/A | N/A | Combined use of prenatal corticosteroids and postnatal surfactant improved neonatal outcome | [114] |
| Dexamethasone + human surfactant | Instillation | Manual after dose | Combined use of prenatal dexamethasone with exogenous surfactant improves the outcome | [115] |
| Curosurf | Intubation | First support by CPAP + manual after each dose | Early treatment of nasal CPAP with single dose of surfactant significantly improves oxygenation and reduces the need for subsequent MV The immediate reinstitution of nasal CPAP after surfactant administration is safe and beneficial |
[129–131] |
| Curosurf | ETT | Yes after delivery | Surfactant is not a vasodilator itself but acts only by improving pulmonary compliance | [132] |
| Dexamethasone (im.) + Survanta or Exosurf (as prophylactic treatment) | ETT | N/A | Combined use of antenatal dexamethasone and postnatal, surfactant does not decrease the rate or severity of RDS in infants delivered at 24–29 weeks gestation, but may be associated with reduced severity of IVH | [116] |
| KL4 surfactant | ETT | Yes | Creates a strong and durable surfactant activity | [133] |
| Curosurf | Intubation | IPPV | Meta-analysis. Prophylactic treatment has significant advantages over rescue therapy | [134] |
| Curosurf | 1 min dual-lumen ETT | Yes | Curosurf dosing via a dual-lumen tracheal tube without MV disconnection and fractional doses can reduce the number of dosing-related adverse transient episodes of hypoxia | [73] |
| Curosurf | A modified Aiolos® nebulizer | First supported by nasal CPAP | No beneficial effects contrary to data from animal trials Delivery optimization of aerosolized surfactant is required |
[56] |
| Infasurf® | Nasopharyngeal instillation | Mask then nasal CPAP after delivery | Safe and simple delivery technique, especially for vaginal births | [84] |
| Survanta | ETT | Yes after delivery | Routine elective intubation for delivery of surfactant to preterm infants having mild to moderate RDS is not recommended | [135] |
| Curosurf | LMA™ | First supported by nasal CPAP | LMA may be a useful and noninvasive conduit for surfactant delivery Randomized controlled clinical trial is needed |
[85] |
| Survanta | ETT | Yes after delivery | A prospective observational study of all cases of RDS treated with surfactant during the period from October 2009 to July 2011 The survival of those given surfactant therapy improved with increasing gestational maturity and birth weight Sepsis is an important complication and its presence, along with a high RDS score at intubation are major predictors of mortality |
[136] |
CLD: Chronic lung disease; CPAP: Continuous positive airway pressure; DPPC: Dipalmitoylphosphatidylcholine; DPPG: Dipalmitoylphosphatidylglycerol; ETT: Endotracheal tube; im.: Intramuscular; IPPV: Intermittent positive pressure ventilator; IVH: Intraventricular hemorrhage; KL4: Cationic and hydrophobic 21-residue lysine and leucine peptide; LMA™: Laryngeal mask airway; MV: Mechanical ventilation; PG: Phosphatidylglcerol; RDS: Respiratory distress syndrome.