SURFACTANT TREATMENT OF THE NEWBORN
Halliday HL
Regional
Neonatal Unit, Royal Maternity Hospital, Belfast and Department of Child
Health, Queen's University of Belfast, Northern Ireland
Objective: This review will discuss
the rationale for surfactant replacement therapy to treat neonatal
respiratory distress syndrome (RDS).
Clinical trial results and recently developed indications for
surfactant treatment will also be discussed.
Methods: Reviews of randomised
clinical trials to examine the type of surfactant, size of dose, timing of
treatment and need for repeated doses will be presented. Systematic reviews published in the
Cochrane Library will be used as a basis for the presentation.
Results: Data exist to show that
natural surfactants are more effective than synthetic, protein free
preparations. Comparative dosing studies suggest that at least 100 mg/kg of
phospholipids are needed for optimal effects. Early treatment is more effective than later treatment
with prophylaxis in the labour ward being preferred for infants of
gestational age less than 27-28 weeks. Repeated doses are more effective than a single dose for
those showing relapse, but with prophylaxis or early treatment a single
dose will suffice for about 75% of infants at risk of developing RDS. Surfactant treatment has been used
in meconium aspiration syndrome, congenital pneumonia, acute RDS (ARDS),
pulmonary hypoplasia, pulmonary haemorrhage and chronic lung disease. There
is some evidence of benefit from treatment for these conditions where
secondary surfactant deficiency occurs.
Conclusions: Successful
surfactant treatment of the newborn was first reported 21 years ago. It has had a major impact in
reducing neonatal mortality and pulmonary air leaks. Third generation surfactants
containing phospholipids and synthetic peptides or proteins are being
developed and will soon be undergoing clinical trials.