[Preterm and term infants with acute respiratory distress syndrome (ARDS): what is the role of surfactant substitution?].

BACKGROUND: Surfactant treatment in preterm infants and term newborns with ARDS-like severe respiratory failure has become part of an individualised treatment strategy in many intensive care units around the world.

DISCUSSION: These babies constitute heterogeneous groups with regards to gestational age, lung maturity, underlying disease processes and postnatal interventions. The pathophysiology of respiratory failure in preterm infants is characterised by a combination of primary surfactant deficiency and surfactant inactivation as a result of plasma proteins leaking into the airways from areas of epithelial disruption and injury. Various pre- and postnatal factors, - such as exposure to chorioamnionitis, pneumonia, fluid lung, sepsis and asphyxia - can induce an injurious inflammatory response in the lung which may subsequently affect surfactant function, synthesis and alveolar stability.

CONCLUSION: Surfactant inactivation and dysfunction is also a hallmark in newborns with meconium aspiration syndrome (MAS), for which a beneficial effect of exogenous surfactant replacement. i.e., reduction of need for ECMO, could be shown. Although for the majority of the above-mentioned diseases process data from randomised, controlled trials are lacking, it is evident from clinical experience that surfactant replacement which counterbalances surfactant inactivation seems to improve oxygenation and lung function in many babies with ARDS without apparent negative side effects. Thus surfactant treatment seems to be justified in many neonates with ARDS.