Aerosol Delivery of Lung Surfactant and Nasal CPAP in the Treatment of Neonatal Respiratory Distress Syndrome

Abstract

After shifting away from invasive mechanical ventilation and intratracheal instillation of surfactant toward non-invasive ventilation with nasal CPAP and less invasive surfactant administration in order to prevent bronchopulmonary dysplasia in preterm infants with respiratory distress syndrome, fully non-invasive surfactant nebulization is the next Holy Grail in neonatology. Here we review the characteristics of animal-derived (clinical) and new advanced synthetic lung surfactants and improvements in nebulization technology required to secure optimal lung deposition and effectivity of non-invasive lung surfactant administration. Studies in surfactant-deficient animals and preterm infants have demonstrated the safety and potential of non-invasive surfactant administration, but also provide new directions for the development of synthetic lung surfactant destined for aerosol delivery, implementation of breath-actuated nebulization and optimization of nasal CPAP, nebulizer circuit and nasal interface. Surfactant nebulization may offer a truly non-invasive option for surfactant delivery to preterm infants in the near future.

Life-saving effect of pulmonary surfactant in premature babies

“…Continued research is needed to identify ways to store and administer surfactant to the vast number of premature babies born in underdeveloped countries who do not have access to this life-saving therapy. Ongoing research aimed at developing a surfactant that could be stored at room temperature and that could be aerosolized to treat neonatal RDS without the need for endotracheal intubation or assisted ventilation currently shows considerable promise ( 27 ).…”

Pulmonary Surfactant: A Mighty Thin Film

“…First, progress in the understanding of surfactant function and dysfunction and our understanding of disease development and progression will improve targeted exogenous surfactant approaches. Second, improved surfactant nebulization methods developed in recent years will allow for early and less-invasive application, before ARDS is fully established. ,,− This would have the potential to curtail the progress of multiorgan injury, the major cause of mortality, on an individualized basis. − Third, the development of more synthetic preparations can be optimized for specific applications such as delivering other therapeutics such as anti-inflammatory agents on an individualized basis. ,, …”