Table 7.

Surfactant replacement therapy for neonates with miscellaneous pulmonary diseases.

Surfactant type	Delivery method	Mechanical ventilation	Disease	Notes	Ref.
Infasurf®	ETT instillation	Yes	ALI	Acute improvement in oxygenation with lower mortality	[174]
Infasurf	Intratracheal instillation	Manual during delivery	AHRF	Improved oxygenation and permitted moderation of ventilator support Multicenter randomized controlled trial is needed	[175]
Infasurf	ETT	Manually ventilated	AHRF	Rapid improvement in oxygenation, earlier extubation, and decreased requirement for intensive care	[176]
BLES®	ETT	Yes	CLD	Useful adjunctive therapy in neonates with early chronic lung disease	[177]
Survanta®	Intratracheal instillation	Yes	CLD	Early postnatal instillation of budesonide using surfactant as vehicle significantly improved the combined outcome of death or CLD Multicenter randomized controlled trial is needed	[178]
Curosurf®	Intubation	IPPV	Severe RDS and CLD	Meta-analysis study of prophylactic versus rescue trials Prophylactic administration demonstrated significant advantages over rescue therapy	[134]
Surfaxin®	Catheter into ETT	Yes	BPD	Reduced the incidence of death or BPD to high-risk preterm infants after the first 48 h of life	[179]
Curosurf	Catheter into ETT	Manual and CPPV	SB	Manual ventilation during delivery then resumed CPPV Improved SB by restoring surfactant activity Larger controlled trial is needed	[180]
Curosurf	Catheter into ETT	Before and after delivery	Severe RSV	Improved gas exchange and respiratory mechanics and shortened MV and ICU stay in infants with RSV-induced respiratory failure	[181]
Curosurf, Survanta, Alveofact®	N/A	N/A	GBS Pneumonia	Surfactant therapy improved gas exchange in term and preterm neonates with GBS pneumonia	[182]
Curosurf then Survanta after detecting the infection	Intratracheal bolus	Yes	ARDS due to chlamydial pneumonia	Extensive further trials are needed to elucidate the efficacy and probable side effects of the treatment plan	[183]
Alveofact	ETT	Yes	Respiratory failure due to bacterial sepsis	Surfactant seems to play a role in the defense against bacteria	[184]
Survanta	ETT	Yes	Respiratory failure requiring ECMO	Multiple-dose surfactant improved pulmonary function, increased surfactant protein A content, reduced disease complications and decreased time on ECMO duration	[185]
Survanta	ETT	Yes but manual during dose delivery	Respiratory failure requiring ECMO	Use of surfactant, particularly in the early phase of respiratory failure, significantly decreased the need for ECMO, without increasing the risk of complications	[186]
Survanta	ETT	Yes	Extremely premature infants	Infants born at or before 26 week of gestation Improves survival rates without increasing the proportion of impaired survivors	[187]
Treated cases: Survanta = 79% Exosurf = 21%	N/A	Yes	High-risk preterm neonates	Neonates weighing 601–1300 g at birth Decreased mortality	[188]
Human surfactant	N/A	N/A	Children born very preterm	Evaluate long-term effects of surfactant therapy Surfactant therapy reducing mechanical ventilation needs or extra oxygen after birth may reduce the severity of immaturity related bronchial obstruction in childhood	[189]
Survanta	ETT	Yes	Congenital PAP associated with SP-B deficiency	Surfactant replacement did not retain surfactant composition, activity or pulmonary vascular permeability	[190]

AHRF: Acute hypoxemic respiratory failure; ALI: Acute lung injury; ARDS: Acute respiratory distress syndrome; BPD: Bronchopulmonary dysplasia; CLD: Chronic lung disease; CPPV: Continuous positive-pressure ventilation; ECMO: Extracorporeal membrane oxygenation; ETT: Endotracheal tube; GBS: Group B streptococcal infection; ICU: Intensive care unit; IPPV: Intermittent positive pressure ventilator; MV: Mechanical ventilation; PAP: Pulmonary alveolar proteinosis; RDS: Respiratory distress syndrome; RSV: Respiratory syncytial virus; SB: Severe bronchiolitis.