Exogenous
surfactant therapy has an established role in the management of
neonatal respiratory distress syndrome (RDS). This article summarises the current evidence on
surfactant therapy. The use of
surfactant for the treatment or prophylaxis of neonatal RDS results in a 30% to 65% relative reduction in the risk of
pneumothorax and up to a 40% relative reduction in the risk of mortality. Adverse effects, of which pulmonary haemorrhage is of most concern, are infrequent and long-term follow-up studies of treated patients are reassuring. Natural
surfactants have advantages over synthetic
surfactants, including a lower frequency of
pneumothorax and a lower mortality. Prophylactic administration of
surfactant is preferred over 'rescue' administration, especially in infants of < 30 weeks' gestation, as it decreases the risk of
pneumothorax,
pulmonary interstitial emphysema and neonatal mortality. Prophylaxis can be administered after initial
resuscitation and stabilisation. In preterm infants who do not receive prophylactic
surfactant, the first dose of
surfactant should be administered as early as possible--early selective treatment decreases the risk of
pneumothorax,
pulmonary interstitial emphysema, chronic
lung disease and neonatal mortality. A regimen of using multiple doses of
surfactant if required has advantages over a single dose regimen. Exogenous
surfactant therapy has also been used in neonatal respiratory disorders other than RDS. In trials in severe
meconium aspiration syndrome,
surfactant therapy reduced the need for
extracorporeal membrane oxygenation. Its role in other disorders requires testing. The development and testing of newer
surfactants is in progress.