Surfactant treatment for premature babies - a review of clinical trials

Article Abstract:

Respiratory distress syndrome (RDS) of the premature infant results in severe impairment of respiration. This condition has been shown to be associated with a deficiency of surfactant, a phosphate and lipid substance that controls the surface tension in the lungs. Various types of artificial surfactant have been developed within the past 10 years, and include surfactant TA developed in Japan; Survanta, a modified form of the Japanese surfactant; surfactant derived from calf lung, pig lung, cow lung, and human amniotic fluid; artificial lung expanding compounds; and Exosurf, a protein-free phospholipid preparation. There have been 15 reports of clinical trials that assessed the effectiveness of surfactant in infants. These included eight studies in which surfactant was used as a prophylactic measure for infants at risk for developing RDS; and seven studies in which surfactant was used to treat infants with RDS who required ventilatory support. Overall, the results of these trials indicate that surfactant is beneficial in infants born at less than 30 weeks' gestation. A major side effect of natural surfactant is an increase in patent ductus arteriosus, the persistent opening of the passage between the pulmonary artery and the aorta. Prophylactic treatment was shown to be beneficial and harmless. Natural surfactant contains proteins that may sensitize the infants, causing the production of antibodies (immune proteins). However, the production of such antibodies do not appear to cause problems. Artificial surfactant was shown to decrease the incidence of complications and improve the outcome of premature infants. The surfactants with longer term benefits include calf lung surfactant, human surfactant, an artificial lung expanding compound used prophylactically, and pig surfactant used for emergency treatments. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Complications and side effects, Drug therapy, Respiratory distress syndrome

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Respiratory compliance in premature babies treated with artificial surfactant (ALEC)

Article Abstract:

Surfactant is a phosphate and lipid compound that controls the surface tension present in the air-liquid interface in the lungs. Treatment of premature infants with surfactant improves ventilation (respiration) and the supply of oxygen to the blood. Previous animal studies showed that surfactant improved respiratory compliance (the force required to distend or expand the lungs) in premature rabbits after one hour of ventilation and one hour of spontaneous breathing. The administration of surfactant to babies born at less than 30 weeks' gestation reduced the pressure required for a mechanical ventilator to expand the lungs. In addition, the treatment decreased the dose of supplemental oxygen, the duration of mechanical ventilation, the duration of oxygen treatment, rate of death, and bleeding within the brain (intracerebral hemorrhage). The effect of surfactant on respiratory compliance was assessed in 294 infants who were born at less than 34 weeks' gestation. Respiratory compliance was measured at 1, 6, 24, 48, and 168 hours after birth. Surfactant significantly improved compliance at 6 and 24 hours after birth in babies born at less than 29 weeks' gestation. Among infants born at more than 29 weeks' gestation, surfactant significantly improved compliance one hour after birth in infants who breathed spontaneously, that is, were not ventilated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Pulmonary function tests, Compliance, Compliance (Psychology)

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Follow up of premature babies treated with artificial surfactant (ALEC) (artificial lung expanding compound) (Fetal and Neonatal Edition)

Article Abstract:

Premature infants are often deficient in lung surfactant, a fatty detergent lining the lungs, which is necessary for healthy lung function. Artificial surfactant has been used successfully to treat premature neonates in several studies, reporting reductions in neonatal mortality from 14 to 27 percent. Premature infants born between 25 and 29 weeks gestation are considered to be at risk for neurological and developmental impairment. (Normal gestation is 37 to 40 weeks.) Follow-up information was available for 231 of 235 surviving premature infants, some of whom were born after 30 weeks' gestation. The developmental progress of most of the babies was evaluated at 9 and 18 months of age. Among the entire group, no differences between surfactant-treated or untreated infants were found in neurologic or mental development, or in the frequency of respiratory infections, allergies and hospital admissions. Among infants born before 30 weeks' gestation, more surfactant-treated infants (57 percent) were normal in terms of developmental and other criteria than nontreated infants (41 percent). (Consumer Summary produced by Reliance Medical Information, Inc.)

Pulmonary surfactant, Pulmonary surfactants

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