Journal List > Korean J Perinatol > v.25(2) > 1013734

Sung: Recent Update in the Treatment of Respiratory Distress Syndrome

Abstract

Respiratory distress syndrome (RDS) is a syndrome caused by pulmonary insufficiency especially in premature infants. It is due to lack of alveolar surfactant along with structural immaturity of the lung. Although recent advances in the management of RDS, it is still a major cause of morbidity and mortality in premature infants. Surfactant replacement therapy is crucial in the management of RDS. Exogenous lung surfactant can be either natural or synthetic. Natural surfactant is extracted from animal sources such as bovine or porcine. Synthetic surfactant is manufactured from compounds that mimic natural surfactant properties. Until recently, natural surfactant extracts would seem to be the more desirable choice. Two basic strategies for surfactant replacement have emerged: prophylactic or preventive treatment, in which surfactant is administered at the time of birth or shortly thereafter to infants who are at high risk for developing RDS from surfactant deficiency; and rescue or therapeutic treatment, in which surfactant is administered after the initiation of mechanical ventilation in infants with clinically confirmed RDS. At least 100 mg/kg of phospholipid is required, but there are pharmacokinetic and clinical data suggesting that 200 mg/kg has a better clinical outcome. Recent recommended method is ‘INSURE’ (Intubate - SURfactant - Extubation) technique. After installation of pulmonary surfactant, reducing the high peak and fluctuations in oxygen saturation are important since these are associated with an increased incidence of retinopathy of prematurity. Non-invasive ventilatory support can reduce the adverse effects associated with intubation and mechanical ventilation, such as bronchopulmonary dysplasia.

REFERENCES

1.Philip AGS. Historical perspectives: the underpinnings of neonatal/perinatal medicine; surfactant deficiency to surfactant use. Neo Reviews. 2002. 3:e239–42.
2.Avery ME., Mead J. Surface properties in relation to atelectasis and hyaline membrane disease. Am J Dis Child. 1959. 97:517–23.
crossref
3.Gruenwald P. Surface tension as a factor in the resistance of neonatal lungs to aeration. Am J Obstet Gynecol. 1947. 53:996–1007.
crossref
4.Fujiwara T., Maeta H., Chida S., Morita T., Watabe Y., Abe T. Artificial surfactant therapy in hyaline membrane disease. Lancet. 1980. 1:55–9.
5.Walsh BK., Daigle B., DiBlasi RM., Restrepo RD. American Association for Respiratory Care clinical practice guideline. Surfactant replacement therapy: 2013. Respir Care. 2013. 58:367–75.
6.Sweet DG., Carnielli V., Greisen G., Hallam M., Ozek E., Plavka R, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants - 2013 update. Neonatology. 2013. 103:353–68.
crossref
7.Sweet D., Bevilacqua G., Carnielli V., Greisen G., Plavka R., Saugstad OD, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome. J Perinat Med. 2007. 35:175–86.
crossref
8.Sweet DG., Carnielli V., Greisen G., Hallman M., Ozek E., Plavka R, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants - 2010 update. Neonatology. 2010. 97:402–17.
crossref
9.Kim YD. New synthetic surfactants for neonates. J Korean Soc Neonatal. 2012. 19:184–94.
crossref
10.Guttentag S., Foster CD. Update in surfactant therapy. Neo-Reviews. 2011. 12:625–33.
crossref
11.Moya FR., Gadzinowski J., Bancalari E., Salinas V., Kopelman B., Bancalari A, et al. 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. 115:1018–29.
crossref
12.Sinha SK., Lacaze-Masmonteil T., Valls i Soler A., Wiswell TE., Gadzinowski J., Hajdu J, et al. A multicenter, randomized, controlled trial of lucinactant versus poractant alfa among very premature infants at high risk for respiratory distress syndrome. Pediatrics. 2005. 115:1030–8.
crossref
13.Bae CW., Hahn WH., Chang JY., Kim SM. Surfactant replacement therapy for RDS: a collaborative study of 72 multi-center trials in Korea (2010) and a review of Korean Experiences over 20 years. J Korean Soc Neonatal. 2011. 18:409–11.
crossref
14.Stevens TP., Harrinton EW., Blennow M., Soll RF. Early surfactant administration with brief ventilation vs selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Syst Rev. 2007. 4:CD003063.
crossref
15.Hoekstra RE., Jackson JC., Myers TF., Frantz ID 3rd., Stern ME., Powers WF, et al. Improved neonatal survival following multiple doses of bovine surfactant in very premature neonates at risk for respiratory distress syndrome. Pediatrics. 1991. 88:10–8.
crossref
16.Kendig JW., Notter RH., Cox C., Reubens LJ., Davis JM., Ma-niscalco WM, et al. A comparison of surfactant as immediate prophylaxis and as rescue therapy in newborns of less than 30 weeks' gestation. N Engl J Med. 1991. 324:865–71.
crossref
17.SUPPORT Study group of the Eunice Kennedy Shriver HICHD Neonatal research network. Finer NN., Carlo WA., Walsh MC., Rich W., Gantz MG, et al. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med. 2010. 362:1970–9.
crossref
18.Sandri F., Plavka R., Ancora G., Simeoni U., Stranak Z., Martinelli S, et al. Prophylactic or early selective surfactant combined with nCPAP in very preterm infants Pediatrics. 2010. 125:1402–9.
19.Halliday HL. Surfactants: past, present and future. J Perinatol. 2008. 28:S47–56.
crossref
20.Kim BI., Choi JW., Yun CK. Changes of respiratory indices and clinical response to the different modes of delivery for administration of surfactant replacement therapy in the respiratory distress syndrome. J Korean Soc Neonatal. 1997. 4:205–16.
21.Cogo PE., Pacco M., Simonato M., Verlato G., Rondina C., Bart-itussion A, et al. Dosing of porcine surfactant: effect on kinetics and gas exchange in respiratory distress syndrome. Pediatrics. 2009. 124:e950–7.
crossref
22.Singh N., Nawley KL., Viswanathan K. Efficacy of porcine versus bovine surfactants for preterm newborns with respiratory distress syndrome: systemic review and meta-analysis. Pediatrics. 2011. 128:e1588–95.
23.Horbar JD., Wright LL., Soll RF., Wright EC., Fanaroff AA., Korones SB, et al. A multicenter randomized trial comparing two surfactants for the treatment of neonatal respiratory distress syndrome. National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr. 1993. 123:757–66.
24.Soll R., Ozek E. Multiple versus single doses of exogenous surfactant for the prevention or treatment of neonatal respiratory distress syndrome. Cochrane Database Synst Rev. 2009. 1:CD000141.
crossref
25.Broadbent R., Fok TF., Dolovich M., Watts J., Coates G., Bowen B, et al. Chest position and pulmonary deposition of surfactant in surfactant depleted rabbits. Arch Dis Child Fetal Neonatal Ed. 1995. 72:F84–9.
crossref
26.Abdel-Latif ME., Osborn DA. Pharyngeal instillation of surfactant before the first breath for prevention of morbidity and mortality in preterm infants at risk of respiratory distress syndrome. Cochrane Database Syst Rev. 2011. 3:CD008311.
crossref
27.Roberts KD., Lampland AL., Meyers PA., Worwa CT., Plumm BJ., Mammel MC. Laryngeal mask airway for surfactant administration in a newborn animal model. Pediatr Res. 2010. 68:414–8.
crossref
28.Dargaville PA. Innovation in surfactant therapy I: surfactant lavage and surfactant administration by fluid bolus using minimally invasive techniques. Neonatology. 2012. 101:326–36.
crossref
29.Pillow JJ., Minocchieri S. Innovation in surfactant therapy II: surfactant administration by aerosolization. Neonatology. 2012. 101:337–344.
crossref
30.Gopel W., Kribs A., Ziegler A., Laux R., Hoehn T., Wieg C, et al. Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. Lancet. 2011. 378:1627–34.
31.Dani C., Corsini I., Bertini G., Pratesi S., Barp J., Rubaltelli FF. Effect of multiple INSURE procedures in extremely preterm infants. J Matern Fetal Neonatal Med. 2011. 24:1427–31.
crossref
32.Bancalari E., Claure N. The evidence for noninvasive ventilation. Arch Dis Child Fetal Neonatal Ed. 2013. 98:98–102.
33.Millar D., Kirpalani H., Lemyre B., Yoder B., Chiu A., Roberts R. Nasal intermittent positive pressure ventilation (NIPPV) does not confer benefit over nasal CPAP (NCPAP) in extremely low birth weight (ELBW) infants - an international randomised trial. Arch Dis Child. 2012. 97:A133–4.

Table 1.
Comparison of Different Natural Surfactants Used in Korea
Source Manufacturer Recommended dose Position Approved day
Surfacten® Minced bovine lung extract Mitsubishi Tanabe Pharma Corporation/JW Pharmaceutical 100 mg/kg phospholipid (4 mL/kg) 4–5 position 1994. 4. 1
Newfectan® Modified bovine-derived extract Yuhan Corporation 120 mg/kg phospholipid (4 mL/kg) 4–5 position 1996. 4. 6
Curosurf® Minced porcine lung extract Chiesi Farmaceutici, Parma/Kolon Pharmaceuticals, Inc. 100–200 mg/kg phospholipid (1.25-2.5 mL/kg) 2 position 2002. 5. 28
Infasurf® Bovine lung lavage extract (calfactant) Ony Inc./Kwang Dong Pharmaceutical Co. Ltd. 105 mg/kg phospholipid (3 mL/kg) 4 position with side-port adapter 2008. 9. 2
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