Controlled Trial of Artificial Surfactant to Prevent Respiratory Distress Syndrome

Halliday, Henry L.; Reid, M; Meban, C.; McClure, G; Lappin, TerenceR.J.; Thomas, P. W.

doi:10.1016/s0140-6736(84)92849-6

Cited by 85 publications

(28 citation statements)

References 16 publications

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“…[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] However, in our study, no such decrease in incidence of air leaks was observed. There was a statistically significant difference in the number of babies developing retinopathy of prematurity (any stage) and the number of babies needing laser treatment for retinopathy of prematurity between the two groups (P = 0.01).…”

Section: Discussioncontrasting

confidence: 52%

“…Randomised controlled trials that compare the prophylactic administration of surfactant to control treatment have been carried out using natural surfactant extracts as well as synthetic surfactant preparations. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Although both prophylactic surfactant administration and surfactant treatment of infants with established respiratory distress syndrome are successful treatment strategies, theoretical advantages have been proposed for each strategy. Prophylactic administration offers the theoretical advantage of replacing surfactant before the onset of respiratory insufficiency, decreasing the need for ventilator support and avoiding barotrauma that may result from even short periods of assisted ventilation.…”

Section: Discussionmentioning

confidence: 99%

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Role of prophylactic surfactant in preterm infants

Singh¹,

Rana²,

Mathai

2011

Medical Journal Armed Forces India

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INTRODUCTIONRespiratory distress syndrome (RDS) in preterm neonates is caused by a deficiency or dysfunction of pulmonary surfactant. Surfactant lines the alveolar surface and prevents atelectasis at end expiration. Pulmonary surfactant is predominantly dipalmitoylphosphatidylcholine with lesser amounts of other phospholipids including phosphatidylglycerol, phosphatidylethanolamine, and phosphatidylinositol. Pulmonary surfactant also contains neutral lipids and distinct surfactant proteins. The physiologic function of surfactant includes the ability to lower surface tension, as well as the ability to rapidly adsorb and spread, associated with the respiratory cycle. The first attempts to utilise synthetic surfactants occurred in the 1960s. The first successful animal model of surfactant replacement therapy was conducted by Enhorning and coworkers in 1972. Enhorning administered a crude natural surfactant extract obtained from lavage of the lungs of mature rabbits 1 directly into the trachea of immature rabbits. Improvement in lung compliance and alveolar expansion was noted. Success in animal models led to widespread clinical trials of surfactant therapy in the human newborns. A systematic review of the seven randomised controlled trials that compare the prophylactic administration of synthetic surfactant to control treatment in preterm infants at risk of developing RDS suggests that prophylactic administration of synthetic surfactant leads to a significant decrease in the risk of pneumothorax, pulmonary interstitial emphysema, and neonatal mortality.2-4 So far, no trials of prophylactic surfactant in preterm neonates were carried out in our country because of the prohibitive cost of the imported drug. During the last decade, preparations of exogenous surfactant have been marketed in our country. This has made it possible to evaluate the prophylactic role of surfactant in preventing respiratory distress syndrome and its associated morbidities in preterm neonates. The present study was designed to find out whether prophylactic administration of surfactant leads to a significant decrease in the risk of neonatal mortality and neonatal morbidity. MATERIALS AND METHODSThis was an experimental study in which a total of 125 preterm newborns less than 34 weeks gestation were studied. The study was carried out in two phases from December 2003 to November 2006. The inclusion criteria were designed to include newborn babies who were less than 34 weeks gestational age at the time of birth. The gestational age assessment was Role of prophylactic surfactant in preterm infants

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Role of prophylactic surfactant in preterm infants

Singh¹,

Rana²,

Mathai

2011

Medical Journal Armed Forces India

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“…[5][6][7][8][9][10][11][12] The main case-control studies investigating the prophylactic or therapeutic use of surfactants were reviewed in two meta-analyses. 13,14 They summarized the evident beneficial effects of surfactant therapy on the natural clinical outcome of RDS.…”

Section: Introductionmentioning

confidence: 99%

Terapia com surfactante pulmonar exógeno em pediatria

Freddi

Filho²,

Fiori³

2003

J. Pediatr. (Rio J.)

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Objective: To review current knowledge about the use of exogenous surfactants in the treatment of different lung diseases causing acute respiratory failure in children. Sources of data:This review is based on the authors' experience and on recent data retrieved from ONIA, Mdconsult, Medline and the Cochrane Database Library. Summary of the findings:In spite of the success of the use of exogenous surfactants in Respiratory Distress Syndrome (RDS) of the newborn, some questions remain unanswered, such as the optimal administration timing -either very early (prophylactic), based on gestational age or on quick tests of lung maturity, or later, when the clinical picture becomes unequivocal. In other severe diseases requiring ventilatory support, the use of surfactants is still controversial, and data in the literature are limited and conflicting. However, successful use in several other diseases has been reported. Recent studies have focused on surfactant inactivation by substances that can be found in the airways. New surfactants with the addition of substances to control inhibition, such as polyethyleneglycol, are being tested for diseases in which inactivation seems to be a significant factor. Conclusions:Therapy with exogenous surfactants, even as a treatment for RDS, has not been thoroughly investigated. Further studies should be conducted to improve surfactants -mainly their resistance to inhibition -and the treatment of diseases other than RDS.J Pediatr (Rio J) 2003;79 (Suppl 2):S205-S12: Exogenous surfactant, respiratory failure, intensive care, respiratory distress syndrome.

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“…Durante a década de 80, vários estudos comprovaram a eficácia das preparações de surfactante "natural" e sintético para o tratamento e prevenção da SDR [5][6][7][8][9][10][11][12] . Os principais estudos que abordaram o uso profilático ou terapêutico do surfactante, em relação a controles, foram agrupados em dois estudos de meta-análise 13,14 .…”

Section: Introductionunclassified

Exogenous surfactant therapy in pediatrics

Freddi¹,

Filho²,

Fiori³

2003

J Pediatr (Rio J)

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ResumoObjetivo: Revisar o estágio atual do conhecimento sobre a utilização do surfactante exógeno nas diferentes doenças pulmonares que levam à insuficiência respiratória aguda em crianças. Fontes dos dados:Este manuscrito baseia-se na experiência clínica dos autores sobre o assunto e na revisão da literatura recente através de consulta aos bancos de dados ONIA, Mdconsult, Medline e Cochrane Database Library. Síntese dos dados:Apesar do sucesso obtido com a utilização do surfactante exógeno na síndrome de desconforto respiratório do recém-nascido, questões permanecem indefinidas, como o momento do seu emprego, muito precoce (profilático), baseado na idade gestacional ou em testes rápidos de maturidade pulmonar, ou então mais tardiamente, após o quadro clínico instalado. Em outras patologias graves que levam à insuficiência respiratória grave com necessidade de suporte ventilatório, o seu uso ainda é controverso, e os dados da literatura são limitados e conflitantes. Porém, relatos de uso clínico em várias destas situações, com sucesso, têm sido freqüentes. A pesquisa em surfactante tem-se centrado ultimamente na sua inativação por várias substâncias que podem estar presentes na via aérea. Nas patologias em que a inativação parece ser um fator importante, novos surfactantes com adição de adjuvantes para reverter a tendência à inativação (por exemplo: polietilenoglicol) estão atualmente em fase de testes. Conclusões:A terapia com surfactante exógeno ainda não é um tema esgotado, nem mesmo na SDR. Os surfactantes podem ser ainda aperfeiçoados, sobretudo para resistir à inibição, e as formas de utilização em outras doenças que não a SDR deverão ser aperfeiçoadas.J Pediatr (Rio J) 2003;79(Supl.2):S205-S212: Surfactante exógeno, insuficiência respiratória, cuidados intensivos, síndrome de desconforto respiratório. AbstractObjective: To review current knowledge about the use of exogenous surfactants in the treatment of different lung diseases causing acute respiratory failure in children. Source of data:This review is based on the authors' experience and on recent data retrieved from ONIA, Mdconsult, Medline and the Cochrane Database Library. Summary of the findings:In spite of the success of the use of exogenous surfactants in Respiratory Distress Syndrome (RDS) of the newborn, some questions remain unanswered, such as the optimal administration timing -either very early (prophylactic), based on gestational age or on quick tests of lung maturity, or later, when the clinical picture becomes unequivocal. In other severe diseases requiring ventilatory support, the use of surfactants is still controversial, and data in the literature are limited and conflicting. However, successful use in several other diseases has been reported. Recent studies have focused on surfactant inactivation by substances that can be found in the airways. New surfactants with the addition of substances to control inhibition, such as polyethyleneglycol, are being tested for diseases in which inactivation seems to be a significant factor. Conclusio...

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Controlled Trial of Artificial Surfactant to Prevent Respiratory Distress Syndrome

Cited by 85 publications

References 16 publications

Role of prophylactic surfactant in preterm infants

Role of prophylactic surfactant in preterm infants

Terapia com surfactante pulmonar exógeno em pediatria

Exogenous surfactant therapy in pediatrics

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