Surfactant replacement therapy for preterm and term. Exogenous surfactants are given at doses between 1020 times the normal pool sizes during surfactant replacement therapy which approximates the pool size in term infants. Goat lung surfactant for treatment of respiratory distress. Surfactant reduced both neonatal mortality and pulmonary air leaks by about 50%. Sep 01, 2009 surfactant replacement therapy is a lifesaving treatment for preterm infants with respiratory distress syndrome, a disorder characterized by surfactant deficiency. Sep 26, 2016 infants receiving surfactant replacement therapy required less ecmo, without a concomitant increase in complications. Surfactant replacement therapy for neonates with respiratory.
Fujiwara t, konishi m, chida s, okuyama k, ogawa y, takecuchi y, et al. Sinkin, md, mph surfactant replacement therapy srt has a proven role in the treatment of neonatal respiratory distress syndrome and severe meconium aspiration syndrome in infants, and may have a role in the treatment of pediatric patients with ards. Beyond respiratory distress syndrome steven m donn md and jennifer dalton md introduction meconium aspiration syndrome surfactant replacement surfactant lavage bronchopulmonary dysplasia summary surfactant replacement therapy is a lifesaving treatment for preterm infants with respiratory. Effects of exogenous surfactant therapy on dynamic compliance during mechanical breathing in preterm infants with hyaline membrane disease. It appears that surfactant replacement therapy for mas consistently improves gas exchange and shortterm outcomes, especially avoidance of air leaks and the need for ecmo. Two basic strategies for surfactant replacement have emerged. Synthetic surfactant for respiratory distress syndrome in. Surfactant replacement therapy srt forms the cornerstone of management of moderate to severe respiratory distress syndrome rds among preterm neonates and it is associated with reduced.
Respiratory distress syndrome rds is a major disease burden in the developing countries. Synthetic lung surfactant drug information, professional. Does nebulised surfactant benefit neonates with respiratory. Rds in a premature infant is defined as respiratory distress requiring more than 30% oxygen delivered by positive pressure using either nasal cpap or an et tube with a chest radiograph that has.
Evolution of surfactant therapy for respiratory distress. Surfactant replacement in neonates by brian walsh for openpediatrics duration. Rds in a premature infant is defined as respiratory distress requiring more than 30% oxygen delivered by. Tremendous progress has been made since the original. Term neonates usually have a surfactant storage pool of approximately 100 mgkg, whereas preterm neonates have an estimated pool only 45 mgkg at birth. Both animal derived surfactant extracts and protein free synthetic surfactant extracts are effective in the treatment and prevention of respiratory distress syndrome. Recommendations for neonatal surfactant therapy 2017. Surfactant therapy for acute respiratory failure in children. Bovine surfactants are known to be clinically equivalent but it is unclear if porcine or bovine surfactants at their licensed dose should be preferred to treat respiratory distress syndrome in preterm neonates. Proceedings of the exosurf neonatal treatment ind investigators meeting. Late surfactant administration in very preterm neonates with. Pulmonary surfactant is a substance that prevents the air sacs of the lungs from collapsing by reducing surface tension. Surfactant replacement therapy should be considered in.
Bovine surfactants are known to be clinically equivalent but it is unclear if porcine or bovine. Currently, exogenous surfactant therapy in adults with ards has failed to demonstrate any beneficial effect on outcome of either mortality or ventilator free days. Since the time when fujiwara first published in 1980, the use of a modified bovine surfactant on ten. Infants receiving surfactantreplacement therapy required less ecmo, without a concomitant increase in complications. Surfactant replacement therapy srt has a proven role in the treatment of neonatal respiratory distress syndrome and severe meconium aspiration syndrome in infants, and may have a role in the treatment of pediatric patients with ards.
Furthermore, prophylactic surfactant administration has not been found to be superior to early selective surfactant administration if ncpap fails 3. To study the effect of exogenous bovine surfactant on oxygen and ventilatory requirements in neonates with respiratory deterioration due to pulmonary hemorrhage. Surfactant therapy is one of the few treatments that have dramatically changed clinical practice in neonatology. Withdraw the mac catheter from the et tube as it severely reduces or occludes the et tube lumen and restricts ventilation which can lead to adverse events desaturation, bradycardia, and chest rigidity. An overview of pulmonary surfactant in the neonate. Currently, exogenous surfactant therapy in adults with ards has failed to demonstrate any beneficial effect on outcome of either mortality or ventilatorfree days. Apr 12, 2014 respiratory distress syndrome rds is a major disease burden in the developing countries. In addition to respiratory distress syndrome rds, surfactant deficiency is observed in many other clinical situations in term and preterm infants, raising several questions regarding the use of surfactant therapy. Surfactant replacement therapy for preterm and term neonates with. Surfactant was the first drug developed solely for treatment of neonates. Mist failure was defined as need for early mechanical ventilation in. Surfactants used in this manner are typically instilled directly into the trachea.
Update in surfactant therapy american academy of pediatrics. Obstetrics, gynecology and reproductive medicine guidelines. Surfactant is composed of lipids, mainly phospholipids, and. Costeffectiveness of a synthetic surfactant therapy for neonatal respiratory distress syndrome. Some new synthetic surfactants containing protein analogues, including chf5633, have recently been studied. Surfactant creates a continuously reforming surface layer. Repletion with exogenous surfactant decreases mortality and thoracic air leaks and is a standard practice in the developed world. Surfactant replacement therapy with a single postventilatory dose of a reconstituted bovine surfactant in preterm neonates with respiratory distress syndrome. Pdf respiratory failure secondary to surfactant deficiency is a major cause of morbidity and mortality in preterm infants. Its introduction was also associated with a 6% reduction in infant mortality in the usa. The technique involves placement of a fine intratracheal catheter while babies keep spontaneously breathing on ncpap. B protein components four surfactant proteins, called spa, spb, spc, and spd, have been identified. Porcine versus bovine surfactant therapy for rds in preterm.
When a baby comes out of the womb and the lungs are not developed yet, they require administration of surfactant in order to process oxygen and survive. Surfactant replacement therapysrt, newborn, survival, risk factors, mortality accepted february 10 2012 introduction surfactant was the first drug developed exclusively for neonates 1. Surfactant replacement therapy srt for preterm neonates with clinical. Surfactant replacement therapy srt in respiratory distress. They showed that low surfactant protein values increased after surfactant administration, with an improvement in the clinical status of the infants, but the effects waned after 1 day. It appears that surfactantreplacement therapy for mas consistently improves gas exchange and shortterm outcomes, especially avoidance of air leaks and the need for ecmo. The mean sd age at which surfactant was given was 5. Respiratory distress syndrome rds due to surfactant deficiency is the most common cause of respiratory failure in preterm infants. Neonatal rds management before surfactant therapy duration.
Exogenous surfactant is used to treat acute respiratory failure in children, although the benefits and harms in this setting are not clear. Exogenous surfactant therapy has become well established in newborn. Surfactant therapy and antibiotics in neonates with. Use of cpap and surfactant therapy in newborns with. In comparison with intubation, use of ncpap is associated with reduced need of surfactant administration, intubation and bronchopulmonary dysplasia in extremely preterm neonates 1, 2. Neonatology intratracheally administered bronchoalveolar fluid derived from calves98% lipids, comprised of 90% phospholipid, especially dipalmitoylphosphatidylcholine and 2% apoproteins, which markedly improves gas exchange in premature infants. Surfactant replacement in neonates by brian walsh for openpediatrics. Halliday in 1959 avery and mead demonstrated that surfactant deficiency was a key feature in the pathogenesis of respiratory distress syndrome rds. Surfactant replacement therapy beyond respiratory distress syndrome in neonates article pdf available in indian pediatrics 533. Mechanical ventilator with flowvolume monitoring or manual neonatal. Surfactant replacement therapy in neonatal respiratory.
Recommendations for neonatal surfactant therapy canadian. Which types of surfactant are effective animalderived or synthetic. Porcine vs bovine surfactant therapy for preterm neonates. Bolus surfactant therapy by tracheal catheterization, another method of administering surfactant while avoiding ventilation, has been developed in german neonatal units. Current evidence supports early continuous positive airway pressure cpap use and early selective surfactant administration as the most efficacious interventions in the management of rds, both in developed and developing countries. Who recommendation on surfactant replacement therapy for.
Surfactant replacement therapy for preterm and term neonates. The surfactantlining alveolar surface is a prerequisite for gas exchange in order to fulfill the energy needs of the living organism. The surfactant lining alveolar surface is a prerequisite for gas exchange in order to fulfill the energy needs of the living organism. Exogenous surfactant therapy increases the pool size rapidly and improves. Meconium aspiration syndrome mas, a common cause of respiratory failure in neonates, is associated with high mortality and morbidity. Porcine vs bovine surfactant therapy for preterm neonates with rds. Pdf surfactant replacement therapy for preterm and term. It is formed by type ii pneumocytes from about 20 weeks of gestation.
Synthetic surfactants versus natural animalderived surfactants for preterm neonates with clinical andor radiologically established respiratory distress syndrome rds. Surfactant therapy in neonates with respiratory deterioration. Surfactant replacement therapy definition of surfactant. Ozek, prophylactic protein free synthetic surfactant for preventing morbidity. First generation protein free synthetic surfactants are not used nowadays.
Infants who received surfactant following a clinically significant pulmonary hemorrhage during the time period july 1991. Animal derived surfactant compared to proteinfree synthetic. Minisymposium neonates surfactant therapy in the newborn c. The gdg noted that proteinfree synthetic surfactants increase the risk. First dose needs to be given as soon as diagnosis of rds is made. In addition to respiratory distress syndrome, other neonatal respiratory disorders are characterized. Fortysix infants weighing 1499 g were randomized into two groups. Pdf surfactant replacement therapy beyond respiratory. Surfactant replacement was established as an effective and safe therapy for immaturityrelated surfactant deficiency by the early 1990s.
Surfactant replacement therapy for rds early rescue therapy should be practiced. According to established guidelines 64, mothers at risk of delivering babies with less. Comparative trials demonstrate greater early improvement in the requirement for ventilator support, fewer pneumothoraces, and fewer deaths associated with animal derived. Synthetic surfactant for respiratory distress syndrome in preterm infants synthetic surfactant is effective in reducing respiratory distress syndrome in preterm babies. Exogenous surfactant is one of only a handful of neonatal therapies that has a strong evidence base, the product of countless basic and clinical studies over roughly 30 years between the first report of respiratory distress syndrome rds as surfactant deficiency and the food and drug administration fda approval of the first surfactant preparation. Surfactant replacement therapy srt, newborn, survival, risk factors, mortality accepted february 10 2012 introduction surfactant was the first drug developed exclusively for neonates 1.
Surfactant therapy an overview sciencedirect topics. These morbidities include deficits in oxygenation, the incidence of pulmonary air leaks pneumothorax and pulmonary interstitial emphysema and. Surfactant replacement therapy is now an integral part of the care of neonates since several clinical trials of natural surfactant extracts and synthetic preparations have shown efficacy in the treatment of infants with hyaline membrane disease. Etiology of surfactant inactivation or dysfunction. Aarc clinical practice guideline surfactant replacement. Surfactant replacement therapy, either as a rescue treatment or a prophylactic natural surfactant therapy, reduces mortality evidence level 1a and several aspects of morbidity in babies with rds. Mist failure was defined as need for early mechanical ventilation surfactant in preterm infants introduction pulmonary surfactant is a complex mixture of phospholipids and proteins that serves to reduce alveolar surface tension. Surfactant therapy is the medical administration of exogenous surfactant. Surfactantreplacement therapy is a lifesaving treatment for preterm infants with respiratory distress syndrome, a disorder characterized by surfactant deficiency. Father interacts with his 4 day old child on an incubator at a neonatal intensive care.
Effect of surfactant on morbidity, mortality, and resource. Surfactant treatment has been shown by careful randomised trials to reduce the mortality and morbidity of very premature babies. Beyond respiratory distress syndrome steven m donn md and jennifer dalton md introduction meconium aspiration syndrome surfactant replacement surfactant lavage bronchopulmonary dysplasia summary surfactantreplacement therapy is a lifesaving treatment for preterm infants with respiratory. Who recommendation on the type of surfactant for surfactant. Many clinical trials have demonstrated that surfactant replacement therapy is a. Surfactant replacement therapy may be considered in. Recommendations for neonatal surfactant therapy ncbi. Feb 02, 2012 this video shows administration of surfactant in nicu by dr ajay agade surfactant is a novel and revolutionary therapy in management of respiratory distress syndrome in neonates. Guidelines for surfactant administration surfactant. Brian walsh discusses the use of surfactant replacement therapy in the treatment of preterm and term neonates suffering from respiratory distress syndrome rds. Although newer delivery mechanisms and strategies are being studied, the classic surfactant administration paradigm consists of endotracheal intubation.
In addition to respiratory distress syndrome, other neonatal respiratory disorders are. This video shows administration of surfactant in nicu by dr ajay agadesurfactant is a novel and revolutionary therapy in management of respiratory distress syndrome in neonates. Objective to evaluate incidence of minimally invasive surfactant therapy mist failure, identify risk factors and assess the impact of mist failure on neonatal outcome. In neonates with rds, surfactant therapy has proven to be efficacious, and in pediatric patients with ards, exogenous surfactant has reduced morbidity and mortality.
911 1113 737 1387 379 909 552 400 1503 437 1354 75 463 1402 1477 1541 1410 172 1370 388 42 1457 944 365 109 1368 389 304 1066 554 90 1303 494 275 1289 1161 571 1471 1109 1414 91 1118 536 138 344 350 505 1067