文本框: Curosurf Clinical Experience in Europe: a 15 year review and perspectives Henry Halliday, Royal Maternity Hospital, Queen's University, Belfast, Northern Ireland, UK Curosurf is a natural surfactant prepared from minced porcine lungs by a process of washing, chloroform-methanol extraction and liquid-gel chromatography It was first developed in Stockholm by Curstedt and Robertson from whom its name, Curosurf is derived. Clinical trials in babies with respiratory distress syndrome were begun in 1983 and the product licence is held by Chiesi Farmaceutici, SpA, Parma, Italy. Curosurf is a highly refined, natural surfactant containing approximately 99% polar lipids and 1% hydrophobic, low molecular weight proteins (SP-B and SP-C). Comparative trials in immature rabbits have shown that Curosurf is superior to synthetic surfactant preparations. Large multicentre clinical trials have shown Curosurf to be well tolerated. Its use is not associated with an increased incidence of complications of prematurity and RDS when compared to controls. Curosurf is administered in a dose of 100 or 200 mg/kg intratracheally as either a single bolus or two aliquots each followed by 1 minute of manual ventilation. Studies have included treatment and prophylaxis. Prophylaxis has been shown to be better than later treatment for babies of less than 30 weeks' gestation. Re-treatment with up to 2 further doses of 100 mg/kg has been shown to improve survival and reduce the risk of pneumothorax compared with a single dose. More than 3 doses is not recommended as further improvement in long-term outcome does not accrue. More than 3000 babies have been treated with Curosurf in randomised trials. These show that treatment reduces the rates of mortality and pulmonary air leak. No adverse effects have been reported and long-term follow-up studies show that survival without disability is increased. Curosurf has been used to treat respiratory conditions other than RDS including ARDS, congenital pneumonia and meconium aspiration syndrome with promising results. Animal studies have shown that Curosurf has beneficial effects for treatment of meconium aspiration. In future the targets for surfactant treatment are likely to widen. Development of next generation surfactants which are less prone to inactivation will probably make these more effective for ARDS and meconium aspiration. These newer surfactants are likely to contain phospholipids and recombinant proteins or peptides. Surfactant treatment has been the greatest development in neonatal medicine for 25 years. Its widespread introduction has been associated with……