SURFACTANT REPLACEMENT THERAPY

Surfactant replacement therapy for treatment or prevention of the resp iratory distress syndrome (RDS) has been studied intensively over the past decade. Randomized controlled trials have demonstrated a reductio n in the odds of neonatal death of about 40% and of pulmonary air leak s of 35 to 70% depending upon the type of surfactant used. Prophylaxis or very early treatment is superior to later treatment, especially fo r the very preterm (<28 week) infant. Natural (derived from animal lun gs) surfactants have a more rapid onset of action than synthetic surfa ctants and may also provide better long-term benefits, but further com parative trials will be needed to demonstrate this conclusively. Surfa ctant treatment should not be viewed as a substitute for prenatal ster oid therapy to enhance fetal lung maturity; the treatments are synergi stic. (C) 1995 Wiley-Liss, Inc.