J Korean Med Assoc.  2015 Apr;58(4):330-335. 10.5124/jkma.2015.58.4.330.

The use of artificial pulmonary surfactant in neonatal respiratory distress

• Choi YS

• KMID: 2194965
• DOI: http://doi.org/10.5124/jkma.2015.58.4.330

Abstract

Pulmonary surfactant instillation is the treatment of choice in neonatal respiratory distress syndrome. The development of artificial surfactant has three decades of history. Animal-derived artificial surfactant is used in most countries and consists of 80% phospholipids and glycerol. 10% of the formulation is comprised of surfactant proteins, which have the critical role in surfactant function of lowering surface tension in the alveoli. Synthetic surfactants are made using synthetic peptide analogues as the surfactant protein counterparts. These are not the same as the human surfactant protein sequences; however, researchers are attempting to find the ideal synthetic peptide sequence for use in synthetic surfactants. Prophylactic and rescue surfactant therapy are two main therapeutic options. A recent recommendation emphasizes the importance of rescue therapy with continuous positive nasal airway pressure, rather than prophylactic use immediate after birth. This article briefly reviews the history and physiology of surfactant use, as well as clinical practice of surfactant and future studies.

Keyword

Pulmonary surfactants; Respiratory distress syndrome, newborn

MeSH Terms

Glycerol
Humans
Parturition
Phospholipids
Physiology
Pulmonary Surfactants*
Respiratory Distress Syndrome, Newborn
Surface Tension
Surface-Active Agents
Glycerol
Phospholipids
Pulmonary Surfactants
Surface-Active Agents

Figure

• 

  Figure 1 Human natural surfactant composition. Most of the human natural surfactant is composed of phosphatidylcholine. Surfactant proteins are another important component although it consists of 11%. PC, phophatidylcholine; DPPC, dipalmitoylphosphatidylcholine.

Reference

1. Clements JA. Surface tension of lung extracts. Proc Soc Exp Biol Med (Maywood). 1957; 95:170–172.

2. Avery ME, Mead J. Surface properties in relation to atelec-tasis and hyaline membrane disease. AMA J Dis Child. 1959; 97:517–523.

3. Fujiwara T, Maeta H, Chida S, Morita T, Watabe Y, Abe T. Artificial surfactant therapy in hyaline-membrane disease. Lancet. 1980; 1:55–59.

4. Robertson B, Curstedt T, Tubman R, Strayer D, Berggren P, Kok J, Koppe J, van Sonderen L, Halliday H, McClure G. A 2-year follow up of babies enrolled in a European multicentre trial of porcine surfactant replacement for severe neonatal respiratory distress syndrome. Collaborative European Multi-centre Study Group. Eur J Pediatr. 1992; 151:372–376.

5. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, Saugstad OD, Simeoni U, Speer CP, Vento M, Halliday HL. European Association of Perinatal Medicine. European consensus guidelines on the management of neonatal res-piratory distress syndrome in preterm infants: 2013 update. Neonatology. 2013; 103:353–368.

6. Metcalfe IL, Pototschnik R, Burgoyne R, Enhorning G. Lung expansion and survival in rabbit neonates treated with surfac-tant extract. J Appl Physiol Respir Environ Exerc Physiol. 1982; 53:838–843.

7. Robertson B, Johansson J, Curstedt T. Synthetic surfactants to treat neonatal lung disease. Mol Med Today. 2000; 6:119–124.

8. Moya FR, Gadzinowski J, Bancalari E, Salinas V, Kopelman B, Bancalari A, Kornacka MK, Merritt TA, Segal R, Schaber CJ, Tsai H, Massaro J, d'Agostino R. International Surfaxin Colla-borative Study Group. A multicenter, randomized, masked, comparison trial of lucinactant, colfosceril palmitate, and beractant for the prevention of respiratory distress syndrome among very preterm infants. Pediatrics. 2005; 115:1018–1029.

9. Kim YD. New synthetic surfactants for neonates. J Korean Soc Neonatol. 2012; 19:184–194.

10. Robillard E, Alarie Y, Dagenais-Perusse P, Baril E, Guilbeault A. Microaerosol administration of synthetic beta-gamma-dipalmitoyl-l-alpha-lecithin in the respiratory distress syn-dome: a preliminary report. Can Med Assoc J. 1964; 90:55–57.

11. Moya F. Synthetic surfactants: where are we? Evidence from randomized, controlled clinical trials. J Perinatol. 2009; 29:S23–S28.

12. Kang JH, Shin SY, Maeng CY, Kim KL, Bae CW, Hahm KS. Preparation and in vitro physical activities of crude natural surfactant and artificial pulmonary surfactant containing synthetic peptide and phospholipid mixtures. J Korean Pediatr Soc. 1998; 41:472–480.

13. Almlen A, Stichtenoth G, Linderholm B, Haegerstrand-Bjork-man M, Robertson B, Johansson J, Curstedt T. Surfactant proteins B and C are both necessary for alveolar stability at end expiration in premature rabbits with respiratory distress syndrome. J Appl Physiol (1985). 2008; 104:1101–1108.

14. Almlen A, Walther FJ, Waring AJ, Robertson B, Johansson J, Curstedt T. Synthetic surfactant based on analogues of SP-B and SP-C is superior to single-peptide surfactants in ventilated premature rabbits. Neonatology. 2010; 98:91–99.

15. Seehase M, Collins JJ, Kuypers E, Jellema RK, Ophelders DR, Ospina OL, Perez-Gil J, Bianco F, Garzia R, Razzetti R, Kramer BW. New surfactant with SP-B and C analogs gives survival benefit after inactivation in preterm lambs. PLoS One. 2012; 7:e47631.

16. Soll RF, Morley CJ. Prophylactic versus selective use of surfac-tant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2001; (2):CD000510.

17. Kirsten GF, Kirsten CL, Henning PA, Smith J, Holgate SL, Bekker A, Kali GT, Harvey J. The outcome of ELBW infants treated with NCPAP and InSurE in a resource-limited institu-tion. Pediatrics. 2012; 129:e952–e959.

18. Kim SM, Park YJ, Chung SH, Choi YS, Kim CH, Bae CW. Early prophylactic versus late selective use of surfactant for respiratory distress syndrome in very preterm infants: a colla-borative study of 53 multi-center trials in Korea. J Korean Med Sci. 2014; 29:1126–1131.

19. SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Finer NN, Carlo WA, Walsh MC, Rich W, Gantz MG, Laptook AR, Yoder BA, Faix RG, Das A, Poole WK, Donovan EF, Newman NS, Ambalavanan N, Frantz ID 3rd, Buchter S, Sánchez PJ, Kennedy KA, Laroia N, Poindexter BB, Cotten CM, Van Meurs KP, Duara S, Narendran V, Sood BG, O'Shea TM, Bell EF, Bhandari V, Watterberg KL, Higgins RD. Early CPAP ver-sus surfactant in extremely preterm infants. N Engl J Med. 2010; 362:1970–1979.

20. Rojas-Reyes MX, Morley CJ, Soll R. Prophylactic versus se-lective use of surfactant in preventing morbidity and mor-tality in preterm infants. Cochrane Database Syst Rev. 2012; 3:CD000510.

21. Gopel W, Kribs A, Ziegler A, Laux R, Hoehn T, Wieg C, Siegel J, Avenarius S, von der Wense A, Vochem M, Groneck P, Weller U, Möller J, Hartel C, Haller S, Roth B, Herting E. German Neonatal Network. Avoidance of mechanical ventil-ation by surfactant treatment of spontaneously breathing pre-term infants (AMV): an open-label, randomised, controlled trial. Lancet. 2011; 378:1627–1634.

22. More K, Sakhuja P, Shah PS. Minimally invasive surfactant administration in preterm infants: a meta-narrative review. JAMA Pediatr. 2014; 168:901–908.

23. Lewis JF, Ikegami M, Jobe AH, Tabor B. Aerosolized surfac-tant treatment of preterm lambs. J Appl Physiol (1985). 1991; 70:869–876.

24. Pillow JJ, Minocchieri S. Innovation in surfactant therapy II: surfactant administration by aerosolization. Neonatology. 2012; 101:337–344.

25. Spragg RG, Lewis JF, Walmrath HD, Johannigman J, Bellingan G, Laterre PF, Witte MC, Richards GA, Rippin G, Rathgeb F, Hafner D, Taut FJ, Seeger W. Effect of recombinant surfactant protein C-based surfactant on the acute respiratory distress syndrome. N Engl J Med. 2004; 351:884–892.