Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Surfactant therapy in preterm infants with respiratory distress syndrome and in near-term or term newborns with acute RDS

Abstract

Many different surfactant preparations derived from animal sources, as well as synthetic surfactants, are available for the treatment of preterm infants with respiratory distress syndrome (RDS). Natural, modified surfactants containing surfactant-associated proteins appear to be more effective than non-protein-containing synthetic surfactants. Comparative trials with poractant alfa at a higher initial dose of 200 mg/kg appear to be associated with rapid weaning of FiO2, less need for additional doses, and decreased mortality in infants <32 weeks gestation when compared with beractant. Early rescue (<30 min of age) surfactant therapy is an effective method to minimize over treatment of some preterm infants who may not develop RDS. Surfactant therapy followed by rapid extubation to nasal ventilation appears to be more beneficial than continued mechanical ventilation. In near-term or term newborns with acute RDS, surfactant therapy has been shown to be 70% effective in improving respiratory failure.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1
Figure 2

References

  1. Martin JA, Hamilton BE, Sutton PD, Menacker F, Munson ML Births: Final Data for 2002. National Center for Health Statistics. Vital Health Stat Series vol. 52, no. 10, 2003.

  2. Lemons JA, Bauer CR, Oh W, Korones S, Papile LA, Stoll BJ et al. Very low-birth weight infant (VLBW) outcomes of the NICHD neonatal research network. Pediatrics 2001; 107: 1–8.

    Article  Google Scholar 

  3. Crowley PA . Antenatal corticosteroid therapy: a meta-analysis of the randomized trials. Am J Obstet Gynecol 1995; 173: 322–335.

    CAS  Article  Google Scholar 

  4. NIH Consensus Development Panel. Effect of corticosteroids for fetal maturation on perinatal outcomes. JAMA 1995; 273: 413–418.

    Article  Google Scholar 

  5. Soll RF . Synthetic surfactant for respiratory distress syndrome in preterm infants (Cochrane Review). In: The Cochrane Library, Issue 4, 2004. John Wiley & Sons, Ltd: Chichester, UK.

    Google Scholar 

  6. Soll RF, Blanco F . Natural surfactant extract versus synthetic surfactant for neonatal respiratory distress syndrome. (Cochrane Review). In: The Cochrane Library, Issue 4, 2004. John Wiley & Sons, Ltd: Chichester, UK.

    Google Scholar 

  7. Horbar JD, Wright LL, Soll RF, Wright EC, Fanaroff AA, Korones SB et al. A multicenter randomized trial comparing two surfactants for the treatment of neonatal respiratory distress syndrome. J Pediatr 1993; 123: 757–766.

    CAS  Article  Google Scholar 

  8. Sehgal SS, Ewing CK, Richards T, Taeusch W . Modified bovine surfactant (survanta) versus a protein free surfactant (exosurf) in the treatment of respiratory distress syndrome in preterm infants: a pilot study. J Natl Med Assoc 1994; 86: 46–52.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. The Vermont Oxford Neonatal Network. A multicenter randomized trial comparing synthetic surfactant with modified bovine surfactant extract in the treatment of neonatal respiratory distress syndrome. Pediatrics 1996; 97: 1–6.

  10. Hudak ML, Farrell EE, Rosenberg AA, Jung AL, Auten RL, Durand DJ et al. A multicenter randomized masked comparison trial of natural versus synthetic surfactant for the treatment of respiratory distress syndrome. J Pediatr 1996; 128: 396–406.

    CAS  Article  Google Scholar 

  11. Hudak ML, Martin DJ, Egan EA, Matteson EJ, Cummings J, Jung AL et al. A multicenter randomized masked comparison trial of synthetic surfactant versus calf lung surfactant extract in the prevention of neonatal respiratory distress syndrome. Pediatrics 1997; 100: 39–50.

    CAS  Article  Google Scholar 

  12. Rollins M, Jenkins J, Tubman R, Corkey C, Wilson D . Comparison of clinical responses to natural and synthetic surfactants. J Perinat Med 1993; 21: 341–347.

    CAS  Article  Google Scholar 

  13. Alvarado M, Hingre R, Hakason D, Gross S . Clinical trial of survanta versus exosurf in infants &lt;1500 g with respiratory distress syndrome. Pediatr Res 1993; 33: 314A.

    Google Scholar 

  14. Pearlman SA, Leef KH, Stefano JL, Spear ML, Esterly KL . A randomized trial comparing exosurf versus survanta in the treatment of neonatal RDS. Pediatr Res 1993; 33: 340A.

    Google Scholar 

  15. Modanlou HD, Beharry K, Padilla G, Norris K, Safvati S, Aranda JV . Comparative efficacy of exosurf and survanta surfactants on early clinical course of respiratory distress syndrome and complications of prematurity. J Perinatol 1997; 17: 455–460.

    CAS  PubMed  Google Scholar 

  16. da Costa DE, Pai MG, Al Khusabiby SM . Comparative trial of artificial and natural surfactants in the treatment of respiratory distress syndrome of prematurity: experience in a developing country. Pediatr Pulmonol 1999; 27: 303–304.

    Article  Google Scholar 

  17. Kukkonen AK, Virtanen M, Jarvenpaa AL, Pokela ML, Ikonen S, Fellman V . Randomized trial comparing natural and synthetic surfactant: increased infection rate after natural surfactant? Acta Pediatr 2000; 89: 556–561.

    CAS  Article  Google Scholar 

  18. Ainsworth SB, Beresford MW, Milligan DWA, Shaw NJ, Matthews JNS, Fenton AC et al. Pumactant and poractant alfa for treatment of respiratory distress syndrome in neonates born at 25–29 weeks’ gestation: a randomised trial. Lancet 2000; 355: 1387–1392.

    CAS  Article  Google Scholar 

  19. Sinha SK, Lacaze-Masmonteil T, Soler A, Wiswell TE, Gadzinowski J, Hajdu J et al. A multicenter, randomized, controlled trial of lucinactant versus poractant alfa among very premature infants at high risk for respiratory distress syndrome. Pediatrics 2005; 115: 1030–1038.

    Article  Google Scholar 

  20. Moya FR, Gadzinowski J, Bancalari E, Salinas V, Kopelman B, Bancalari A et al. A multicenter, randomized, masked, comparison trial of lucinactant, colfosceril palmitate, and beractant for the prevention of respiratory distress syndrome among very preterm infants. Pediatrics 2005; 115: 1018–1029.

    Article  Google Scholar 

  21. Notter RH . Lung biology in health and disease. Lung Surfactants: Basic Science and Clinical Applications, vol 149. Marcel Dekker Inc.: New York, 2000. pp 281–298.

    Chapter  Google Scholar 

  22. Bloom BT, Kattwinkel J, Hall RT, Delmore PM, Egan EA, Trout JR et al. Comparison of infasurf (calf lung surfactant extract) to survanta in the treatment and prevention of respiratory distress syndrome. Pediatrics 1997; 100: 31–38.

    CAS  Article  Google Scholar 

  23. Speer CP, Gefeller O, Groneck P, Laufkotter E, Roll C, Hanssler L et al. Randomised clinical trial of two treatment regimens of natural surfactant preparations in neonatal respiratory distress syndrome. Arch Dis Child Fetal Neonatal Ed 1995; 72: F8–F13.

    CAS  Article  Google Scholar 

  24. Baroutis G, Kaleyias J, Liarou T, Papathoma E, Hatzistamatiou Z, Costalos C . Comparison of three treatment regimens of natural surfactant preparations in neonatal respiratory distress syndrome. Eur J Pediatr 2003; 162: 476–480.

    CAS  Article  Google Scholar 

  25. Ramanathan R, Rasmussen MR, Gerstmann DR, Finer N, Sekar K, North American Study Group. A randomized, multicenter masked comparison trial of poractant alfa (curosurf) versus beractant (survanta) in the treatment of respiratory distress syndrome in preterm infants. Am J Perinatol 2004; 21: 109–119.

    Article  Google Scholar 

  26. Malloy CA, Nicoski P, Muraskas JM . A randomized trial comparing beractant and poractant treatment in neonatal respiratory distress syndrome. Acta Paediatr 2005; 94: 779–784.

    Article  Google Scholar 

  27. Bloom BT, Clark RH . Comparison of infasurf (calfactant) and survanta (beractant) in the prevention and treatment of respiratory distress syndrome. Pediatrics 2005; 116: 392–399.

    Article  Google Scholar 

  28. Marsh W, Smeeding J, York JM, Ramanathan R, Sekar K . A cost minimization comparison of two surfactants, beractant and poractant alfa, based upon prospectively designed, comparative clinical trial data. J Pediatr Pharmacol Ther 2004; 9: 113–121.

    Google Scholar 

  29. Verder H, Robertson B, Greisen G, Ebbesen F, Albertsen P, Lundstrom K et al. Surfcatant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. N Engl J Med 1994; 331: 1051–1055.

    CAS  Article  Google Scholar 

  30. Verder H, Albertsen P, Ebbesen F, Greisen G, Robertson B, Bertelsen A et al. Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks’ gestation. Pediatrics 1999; 103: e24.

    CAS  Article  Google Scholar 

  31. Haberman B, Shankaran S, Stevenson DK, Papile LA, Stark A, Korones S et al. Does surfactant and immediate extubation to nasal continuous positive airway pressure reduce use of mechanical ventilation? Pediatr Res 2002; 51: 349A.

    Google Scholar 

  32. D’Angio CT, Khalak R, Stevens TP, Reininger A, Reubens L, Kendig JW et al. Intratracheal surfactant administration by transient intubation in infants 29–35 weeks’ gestation with RDS requiring nasal CPAP decreases the likelihood of later mechanical ventilation: a randomized controlled trial. Pediatr Res 2003; 53: 367A.

    Google Scholar 

  33. Soll RF, Conner JM, Howard D, the investigators of the early surfactant replacement study. Early surfactant replacement in spontaneously breathing premature infants with RDS. Pediatr Res 2003; Late breaker abstract 12, PAS 2003 meeting.

  34. Dani C, Bertini G, Pezzati M, Cecchi A, Caviglioli C, Rubaltelli FF . Early extubation and nasal continuous positive airway pressure after surfactant treatment for respiratory distress syndrome among preterm infants &lt;30 weeks’ gestation. Pediatrics 2004; 113: e560–e563.

    Article  Google Scholar 

  35. The Texas Neonatal Research Group. Early surfactant for neonates with mild to moderate respiratory distress syndrome: a multicenter, randomized trial. J Pediatr 2004; 144: 804–808.

  36. Sahni R, Ammari A, Suri MS, Milisavljevic V, Ohira-Kist K, Wung JT et al. Is the new definition of bronchopulmonary dysplasia more useful? J Perinatol 2005; 25: 41–46.

    Article  Google Scholar 

  37. Lewis JF, Brackenbury A . Role of exogenous surfactant in acute lung injury. Crit Care Med 2003; 31: S324–S328.

    CAS  Article  Google Scholar 

  38. Herting E, Gefeller O, Land M, Sonderen L, Harms K, Robertson B, Members of the Collaborative European Multicenter Study Group. Surfactant treatment of neonates with respiratory failure and Group B streptoloccal infection. Pediatrics 2000; 106: 957–964.

    CAS  Article  Google Scholar 

  39. Findley RD, Taeusch W, Walther FJ . Surfactant replacement therapy for meconium aspiration syndrome. Pediatrics 1996; 97: 48–52.

    Google Scholar 

  40. Lotze A, Mitchell BR, Bulas DI . Multicenter study of surfactant (beractant) use in the treatment of term infants with severe respiratory failure. J Pediatr 1998; 132: 40–47.

    CAS  Article  Google Scholar 

  41. Marks SD, Nicholl RM . The reduction in the need for ECMO by using surfactant for meconium aspiration syndrome. J Pediatr 1999; 135: 267–268.

    CAS  Article  Google Scholar 

  42. Wiswell TE, Knight GR, Finer NN, Donn SM, Desai H, Walsh WF et al. A multicenter, randomized controlled trial comparing surfaxin (lucinactant) lavage with standard care for treatment of meconium aspiration syndrome. Pediatrics 2002; 109: 1081–1087.

    Article  Google Scholar 

  43. Anderson JM and the Congenital Diaphragmatic Hernia Study Group. Is surfactant therapy beneficial in the management of congenital diaphragmatic hernia? Pediatr Res 2003; Late breaker abstract 13, PAS 2003 meeting.

  44. Luchetti M, Ferraro F, Gallini C, Natale A, Pigna A, Tortorolo L et al. Multicenter, randomized, controlled study of porcine surfactant in severe respiratory syncytial virus-induced respiratory failure. Pediatr Crit Care Med 2002; 3: 261–268.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R Ramanathan.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ramanathan, R. Surfactant therapy in preterm infants with respiratory distress syndrome and in near-term or term newborns with acute RDS. J Perinatol 26, S51–S56 (2006). https://doi.org/10.1038/sj.jp.7211474

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211474

Keywords

  • poractant
  • beractant
  • preterm infants
  • nasal continuous positive airway pressure

Further reading

Search

Quick links