Late Surfactant Administration in Very Preterm Neonates With Prolonged Respiratory Distress and Pulmonary Outcome at 1 Year of Age

Because the lungs are one of the last organs to develop, their function is a major concern in infants born prematurely. Premature neonates may require mechanical ventilation if their lungs have not fully developed and they are not able to breathe sufficiently on their own. Mechanical ventilation (along with other factors) in infants can lead to an increased risk of developing bronchopulmonary dysplasia, which leads to chronic lung disease and abnormal neurodevelopment. Surfactant is a substance produced in the lungs that decreases surface tension in the lungs and stabilizes alveoli, ultimately preventing the lung from collapsing when exhaling. Surfactant can also be produced exogenously and can be used to treat premature infants.

This randomized, controlled, double-blind study examined the effects of late surfactant administration in 118 infants who were born before 33 weeks’ gestation and still required mechanical or high-frequency oscillatory ventilation at 14 days old. The primary end point was the time to first successful extubation; secondary outcomes were respiratory outcomes at 36 weeks postmenstrual age and at one year. Infants either received the treatment of surfactant or air. The results showed that the two groups were not significantly different in time to first successful extubation or respiratory outcomes at 36 weeks’ postmenstrual age. Bronchopulmonary dysplasia severity was also similar in both groups. There was a significant difference between the treatment and control in the number of hospitalizations required for respiratory issues at one year of age. The study concluded that surfactant was a safe therapy and that it did allow for better pulmonary outcomes at one year of age.

This study is just one example of the usefulness of synthesis of exogenous versions of endogenous substances to treat certain diseases. Although the study did not show overly successful outcomes, it was very logical to try to replace the substance that was missing in these infants, and this strategy could likely be used to find treatments for other diseases. Also, I really like seeing studies done in infants because they are an extremely vulnerable population and must be treated in different ways than adults or even children. I think it is very important to continue to do research on therapies specifically for infants.

 

JAMA Pediatr. doi: 10.1001/jamapediatrics.2015.4617 (published February 29, 2016).

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