SYNTHETIC OR NATURAL SURFACTANTS

Surfactant replacement therapy is one of the most studied intervention s in neonatal medicine, with many thousands of infants having been enr olled in randomized clinical trials. It is clear that surfactant thera py reduces neonatal mortality and the risk of pulmonary air leaks in b abies with or at risk of developing respiratory distress syndrome. Yet some doubts linger over other aspects of this therapy, despite it hav ing been an acceptable and proven therapy for the past 7-10 years. As regards timing of treatment, the earlier the better, with true prophyl axis being reserved for babies of less than 28 weeks' gestation. Natur al surfactant preparations containing surfactant proteins B and C act more rapidly than their synthetic protein-free counterparts and probab ly also have a greater impact on reducing neonatal mortality and pulmo nary air leaks. Fears raised about immunological effects, prion transm ission and chemical contamination of natural surfactants have not been substantiated. Long-term follow-up studies do not show any difference s in outcome between treated and non-treated infants, except that the incidence and severity of retinopathy of prematurity might be reduced by treatment with natural surfactant. Further research is needed and t his will include more detailed follow-up studies, newer indications fo r surfactant therapy and the testing of newer preparations with synthe tic peptides or protein analogues added.