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Neonatal diseases II
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Brian P. Hackett, Jeffrey Dawson, Akshaya Vachharajani, Barbara Warner, F. Sessions Cole
In 1959, Mary Ellen Avery and Jere Mead described the relationship between preterm birth, lung surface tension, and RDS (21). Since that time, understanding the biology of pulmonary surfactant and its role in preterm respiratory distress has been one of the triumphs of newborn medicine. This understanding has led to the use of exogenous surfactant replacement as a primary treatment for preterm RDS. Available surfactant preparations include bovine- or porcine-derived products and synthetic surfactant preparations that are administered to preterm infants via endotracheal tube. Multiple studies have demonstrated the efficacy of exogenous surfactant in reducing newborn mortality and airleaks, especially when given as multiple doses early after birth in a prophylactic, as opposed to rescue, manner (22,23). Although a consistent reduction in the development of chronic lung disease (bronchopulmonary dysplasia) in preterm infants treated with surfactant has not been demonstrated, there is evidence that the severity of chronic lung disease has decreased in the era of surfactant therapy (24). Combined management strategies, for example, surfactant treatment and early extubation to continuous positive airway pressure (CPAP), show promise in decreasing not only the severity but the incidence of chronic lung disease in preterm infants with RDS as well (25,26).
The twentieth century
Published in Michael J. O’Dowd, The History of Medications for Women, 2020
Corticosteroid treatment was associated with a reduction in the risk of neonatal death from intraventricular hemorrhage. Corticosteroids also enhanced the efficacy of neonatal surfactant therapy by improving fetal lung maturation and increasing the production of endogenous surfactant. In research that was years ahead of its time, Enhorning and Robertson (1972) experimented with the tracheal deposition of surfactant in premature rabbits. Surfactant became commercially available for use in premature infants almost 20 years later.
Functional Exploration of the Lung in Neonatal Respiratory Distress Syndrome: Use of Animal Models for the Study of Respiratory Distress
Published in Jacques R. Bourbon, Pulmonary Surfactant: Biochemical, Functional, Regulatory, and Clinical Concepts, 2019
The beneficial effects of surfactant therapy have been studied in the rhesus monkey and baboon. In the rhesus monkey, Cutz et al.128 observed that neonatal adaptation was facilitated by tracheal deposition of heterogenous surfactant before the onset of breathing. Enhörning et al.129 reported that tracheal instillation of natural surfactant was followed by an improvement in the A-aDO2 and post-mortem P/V curves. In the premature baboon, surfactant therapy efficacy was followed on the a/A O2 ratio and/or compliance measurements. Compliance was calculated by noting the tidal volume at 29 cm H2O distending pressure. Bovine surfactant therapy delivered into the trachea at 2 h of life improved the a/A O2 ratio and compliance during the following hours (Figure 6). At autopsy, the P/V curves were significantly different, with large hysteresis in the surfactant-treated group.
The COVID-19 pandemic: a target for surfactant therapy?
Published in Expert Review of Respiratory Medicine, 2021
Ruud A.W. Veldhuizen, Yi Y. Zuo, Nils O. Petersen, James F. Lewis, Fred Possmayer
The current review will explore the above considerations as they relate to the potential of exogenous surfactant therapy for COVID-19 patients. This approach represents a supportive therapy aimed at mitigating the progression of lung injury in patients with lung dysfunction due to COVID-19. As of the writing of this review there are five clinical trials of surfactant therapy for COVID-19 patients registered (Table 1) [1–5] and an initial report has been published on the utilization of this therapy in five individual patients [6]. We will provide an overview of surfactant function as well as both the success and failures of exogenous surfactant therapy in neonatal and adult respiratory distress syndrome. Subsequently, we will discuss five guiding postulates deemed important for the design and interpretation of clinical studies on exogenous surfactant therapy for COVID-19.
Advances in the Pharmacological Management of Pediatric Acute Respiratory Distress Syndrome
Published in Expert Opinion on Pharmacotherapy, 2022
Maria Gabriella Matera, Francesco Imperatore, Rosa Annibale, Mario Cazzola
Much attention must also be paid to surfactant replacement therapy. Certainly, as we have pointed out, the available data do not support its use in PARDS, but it has been correctly highlighted that before abandoning such a therapeutic approach it is useful to verify whether there are conditions that could explain the inconsistency of results in children and that could be overcome [87]. The different origins of lung disease, the type of lung damage, the mode of administration of surfactant therapy, and the type of surfactant used all play an important role. The European Society for Pediatric and Neonatal Intensive Care (ESPNIC) expert consensus opinion for future research in the field is that any study wishing to examine the prospective of surfactant replacement therapy in PARDS must enroll patients as homogeneous as possible, thus choosing an explanatory rather than a pragmatic design with a highly specific selection or stratification, and in any case designed to aim at significant clinical results but also at pathophysiological and/or biological or biophysical measures [88]. In any case, to avoid heterogeneity of subjective characteristics, patients should be enrolled according to currently available definitions and considering recent pathobiological knowledge. In addition, it is essential that the study design starts from the key characteristics, such as direct or indirect (primary or secondary) nature, clinical severity, infectious or noninfectious origin, or age of the patients and, in any case, chooses different clinical outcomes considering its phase, the trigger involved and the severity class of the patients to be studied.
Anti-IL-8 antibody potentiates the effect of exogenous surfactant in respiratory failure caused by meconium aspiration
Published in Experimental Lung Research, 2018
Pavol Mikolka, Jana Kopincova, Petra Kosutova, Maros Kolomaznik, Andrea Calkovska, Daniela Mokra
Surfactant therapy (M + S group) consisted of the “therapeutic” lung lavage with diluted surfactant (Curosurf, 10 ml/kg, 5 mg PL/ml) given twice in the semiupright right and left lateral animal positions, each followed by the tracheal suction using suction device. This procedure served for a partial washout of instilled meconium. Subsequently, a dose of undiluted Curosurf (100 mg PL/kg, 1.25 ml/kg) was administered via jet of ventilator using asymmetric high-frequency jet ventilation (or inpulsion regime of HFJV) (f. 300/min, Ti 20%, PIP/PEEP 1.5/0.3 kPa) which enabled a homogenous spreading of given surfactant to supplement the loss of endogenous surfactant caused by inactivation by meconium.[15]