The Role of Surfactant in Respiratory Distress Syndrome

Abstract

The key feature of respiratory distress syndrome (RDS) is the insufficient production of surfactant in the lungs of preterm infants. As a result, researchers have looked into the possibility of surfactant replacement therapy as a means of preventing and treating RDS. We sought to identify the role of surfactant in the prevention and management of RDS, comparing the various types, doses, and modes of administration, and the recent development. A PubMed search was carried out up to March 2012 using phrases: surfactant, respiratory distress syndrome, protein-containing surfactant, protein-free surfactant, natural surfactant, animal-derived surfactant, synthetic surfactant, lucinactant, surfaxin, surfactant protein-B, surfactant protein-C.Natural, or animal-derived, surfactant is currently the surfactant of choice in comparison to protein-free synthetic surfactant. However, it is hoped that the development of protein-containing synthetic surfactant, such as lucinactant, will rival the efficacy of natural surfactants, but without the risks of their possible side effects. Administration techniques have also been developed with nasal continuous positive airway pressure (nCPAP) and selective surfactant administration now recommended; multiple surfactant doses have also reported better outcomes. An aerosolised form of surfactant is being trialled in the hope that surfactant can be administered in a non-invasive way. Overall, the advancement, concerning the structure of surfactant and its mode of administration, offers an encouraging future in the management of RDS.

An update on pharmacologic approaches to bronchopulmonary dysplasia

“…However, the United States Food and Drug Administration (FDA) approved the protein-containing synthetic surfactant lucinactant for commercial use in March 2012. It contains a 21-residue synthetic peptide that mimics the function of surfactant protein B 47 . Synthetic surfactant may eliminate the risks of inflammation and immunogenicity associated with animal derived surfactant 48 .…”

Development of a Synthetic Surfactant Using a Surfactant Protein-C Peptide Analog:In VitroStudies of Surface Physical Properties

“…Bovine surfactants (Surfacten®, Survanta®, Infasurf®, Alveofact®, Newfactan®) and porcine surfactants (Curosurf®), which have all been clinically proven to be effective, are used worldwide. 1 2 3 22 23 24 25 26 27 According to a recent search in the Cochrane database of systematic reviews of several meta-analyses of these agents, the overall relative risk of mortality was decreased when the following procedures were observed with such agents: 1) administration of multiple doses rather than a single dose, 0.63; 2) use of animal-derived surfactant rather than synthetic surfactants, 0.86; 3) prophylactic rather than selective use, 0.61; 4) early rather than delayed selective treatment, 0.87; and 5) use of the INSURE (INtubation SURfactant Extubation) technique rather than surfactant administration followed by continued mechanical ventilation, 0.38 in preterm newborns with RDS. 2 28 29 30 31 Exogenous surfactants also decreased neonatal mortality and neonatal pneumothorax by 50% and improved overall infant mortality by 6% in the United States.…”

Quantitative lipidomic analysis of mouse lung during postnatal development by electrospray ionization tandem mass spectrometry

“…Maintenance of adequate DPPC within air space is essential for normal lung function [ 58 ]. RDS is the major cause of mortality and morbidity in premature infants diagnosed with mainly DPPC deficiency in quantity and quality of pulmonary surfactant [ 59 ]. Currently, surfactant replacement therapy with added products of DPPC is an effective therapeutic strategy available for RDS management [ 60 ].…”