The rationale for
surfactant replacement
therapy (SRT) in preterm neonates with
respiratory distress syndrome (RDS) was presented. Findings on the biophysical properties of
surfactant preparations based on natural components, including the hydrophobic
polypeptides SP-B and SP-C were discussed, along with clinical experience with a reconstituted
bovine lung surfactant (
Surfactant-TA). Since the first successful clinical use of this
surfactant in 1980, a number of subsequent studies have confirmed that SRT can modify the course of RDS. Factors affecting the response to
surfactant replacement
therapy with
Surfactant-TA were also addressed. One controversial issue was the relative effectiveness of prophylactic versus rescue strategies. In our recent prospective randomized trial, prophylactic use of
Surfactant-TA prevented the development of RDS completely, and thereby reduced the incidence of chronic
lung disease (odds ratio, 0.08 (92% reduction); p = 0.016). This study differed from other similar studies of different
surfactants in that only babies with documented
surfactant deficiency were included. Our recent in vivo studies showed that
Surfactant-TA is Superior to
survanta and to totally synthetic
surfactants available for clinical use.