Am J Perinatol 2000; 17(7): 335-344
DOI: 10.1055/s-2000-13445
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

THE SURFACTANTS

Suhas Kallapur, Machiko Ikegami
  • Children's Hospital Medical Center, Division of Pulmonary Biology, Cincinnati, Ohio
Further Information

Publication History

Publication Date:
31 December 2000 (online)

ABSTRACT

Surfactants have been routinely used since 1990 for the treatment of respiratory distress syndrome (RDS). The use of surfactant has coincided with a decrease in mortality in infants due to RDS. This review focuses on clinical aspects of surfactant use. New information, particularly effects of ventilatory styles on surfactant function, is presented.

REFERENCES

  • 1 Avery M, Mead J. Surface properties in relation to atelectasis and hyaline membrane disease.  Amer Dis Child . 1959;  97 517-523
  • 2 Enhorning G, Hill D, Sherwood G, Cutz E, Robertson B, Bryan C. Improved ventilation of prematurely delivered primates following tracheal deposition of surfactant.  Am J Obstet Gynecol . 1978;  132 529-536
  • 3 Enhorning G, Robertson B. Lung expansion in the premature rabbit fetus after tracheal deposition of surfactant.  Pediatrics . 1972;  50 58-66
  • 4 Enhorning G, Grossman G, Robertson B. Effect of tracheal deposition of surfactant on air expansion of lungs: study on premature rabbit fetuses.  Arch Dis Child . 1973;  48 162
  • 5 Robertson B, Enhorning G. The alveolar lining of the premature newborn rabbit after pharyngeal deposition of surfactant.  Lab Invest . 1974;  31 54-59
  • 6 Fujiwara T, Maeta H, Chida S, Morita T, Watabe Y, Abe T. Artificial surfactant therapy in hyaline-membrane disease.  Lancet . 1980;  1 55-59
  • 7 Hamvas A, Wise P, Yang R. The influence of the wider use of surfactant therapy on neonatal mortality among blacks and whites.  N Engl J Med . 1996;  334 1635-1640
  • 8 Palta M, Weinstein M, McGuinness G, Gabbert D, Brady W, Peters M. A population study: mortality and morbidity after availability of surfactant therapy. Newborn Lung Project.  Arch Pediatr Adolesc Med . 1994;  148 1295-1301
  • 9 Horbar J, Wright E, Onstad L. Decreasing mortality associated with the introduction of surfactant therapy: an observational study of neonates weighing 601 to 1300 grams at birth. The Members of the National Institute of Child Health and Human Development Neonatal Research Network.  Pediatrics . 1993;  92 191-196
  • 10 Lee K, Khoshnood B, Wall S, Chang Y, Hsieh H, Singh J. Trend in mortality from respiratory distress syndrome in the United States: 1970-1995.  J Pediatr . 1999;  134 434-440
  • 11 Johansson J, Curstedt T. Molecular structures and interactions of pulmonary surfactant components.  Eur J Biochem . 1997;  244 675-693
  • 12 Hallman M, Miyai K, Wagner R. Isolated lamellar bodies from rat lung: correlated ultrastructural and biochemical studies.  Lab Invest . 1976;  35 79-86
  • 13 Williams M. Ultrastructure of tubular myelin and lamellar bodies in fast-frozen adult rat lung.  Exp Lung Res . 1982;  4 37-46
  • 14 Wright J. Immunomodulatory functions of surfactant.  Physiol Rev . 1997;  77 931-962
  • 15 LeVine A, Gwozdz J, Stark J, Bruno M, Whitsett J, Korfhagen T. Surfactant protein-A enhances respiratory syncytial virus clearance in vivo.  J Clin Invest . 1999;  103 1015-1021
  • 16 LeVine A, Bruno M, Huelsman K, Ross G, Whitsett J, Korfhagen T. Surfactant protein A-deficient mice are susceptible to group B streptococcal infection.  J Immunol . 1997;  158 4336-4340
  • 17 LeVine A, Kurak K, Bruno M, Stark J, Whitsett J, Korfhagen T. Surfactant protein-A-deficient mice are susceptible to Pseudomonas aeruginosa infection.  Am J Respir Cell Mol Biol . 1998;  19 700-708
  • 18 Elhalwagi B, Zhang M, Ikegami M. Normal surfactant pool sizes and inhibition-resistant surfactant from mice that overexpress surfactant protein A.  Am J Resp Cell Mol Biol . 1999;  21 380-387
  • 19 Botas C, Poulain F, Akiyama J. Altered surfactant homeostasis and alveolar type II cell morphology in mice lacking surfactant protein D.  Proc Natl Acad Sci USA . 1998;  95 11869-11874
  • 20 Korfhagen T, Sheftelyevich V, Burhans M. Surfactant protein-D regulates surfactant phospholipid homeostasis in vivo.  J Biol Chem . 1998;  273 28438-28443
  • 21 Whitsett J, Wert S, Jones T, Fisher J, Korfhagen T. Spontaneous emphysema in SP-D targeted mice.  Am J Resp Crit Care Med . 1999;  159 A729
  • 22 Clark J, Wert S, Bachurski C. Targeted disruption of the surfactant protein B gene disrupts surfactant homeostasis, causing respiratory failure in newborn mice.  Proc Natl Acad Sci USA . 1995;  92 7794-7798
  • 23 Vorbroker D, Profitt S, Nogee L, Whitsett J. Aberrant processing of surfactant protein C in hereditary SP-B deficiency.  Am J Physiol . 1995;  268 L647-L656
  • 24 Nogee L, Garnier G, Dietz H. A mutation in the surfactant protein B gene responsible for fatal neonatal respiratory disease in multiple kindreds.  J Clin Invest . 1994;  93 1860-1863
  • 25 Rider E, Jobe A, Ikegami M, Sun B. Different ventilation strategies alter surfactant responses in preterm rabbits.  J Appl Physiol . 1992;  73 2089-2096
  • 26 Jobe A. Pulmonary surfactant therapy.  N Engl J Med . 1993;  328 861-868
  • 27 Soll R. Appropriate surfactant usage in 1996.  Eur J Pediatr . 1996;  155(Suppl 2) S8-S13
  • 28 Jobe A, Ikegami M. Mechanisms initiating lung injury in the preterm.  Early Hum Dev . 1998;  53 81-94
  • 29 Raju T, Langenberg P. Pulmonary hemorrhage and exogenous surfactant therapy: a meta-analysis.  J Pediatr . 1993;  123 603-610
  • 30 Kendig J, Notter R, Cox C. A comparison of surfactant as immediate prophylaxis and as rescue therapy in newborns of less than 30 weeks' gestation.  N Engl J Med . 1991;  324 865-871
  • 31 Egberts J, de Winter P J, Sedin G. Comparison of prophylaxis and rescue treatment with Curosurf in neonates less than 30 weeks' gestation: a randomized trial.  Pediatrics . 1993;  92 768-774
  • 32 Kattwinkel J, Bloom B, Delmore P. Prophylactic administration of calf lung surfactant extract is more effective than early treatment of respiratory distress syndrome in neonates of 29 through 32 weeks' gestation.  Pediatrics . 1993;  92 90-98
  • 33 Walti H, Paris-Llado J, Breart G, Couchard M. Porcine surfactant replacement therapy in newborns of 25-31 weeks' gestation: a randomized, multicentre trial of prophylaxis versus rescue with multiple low doses. The French Collaborative Multicentre Study Group.  Acta Paediatrica . 1995;  84 913-921
  • 34 Merritt T, Hallman M, Berry C. Randomized, placebo-controlled trial of human surfactant given at birth versus rescue administration in very low birth weight infants with lung immaturity.  J Pediatr . 1991;  118 581-594
  • 35 Dunn M, Shennan A, Zayack D, Possmayer F. Bovine surfactant replacement therapy in neonates of less than 30 weeks' gestation: a randomized controlled trial of prophylaxis versus treatment.  Pediatrics . 1991;  87 377-386
  • 36 Soll R F, Morley C J. Prophylactic versus selective use of surfactant for preventing morbidity and mortality in preterm infants (Cochrane review).  The Cochrane Library, Issue 4, Oxford: Update Software 1999
  • 37 Soll R. Surfactant treatment of the very preterm infant.  Biol Neonate . 1998;  74(Suppl 1) 35-42
  • 38 The OSIRIS Collaborative Group. Early versus delayed neonatal administration of a synthetic surfactant: the judgment of OSIRIS. Open study of infants at high risk of or with respiratory insufficiency: the role of surfactant.  Lancet . 1992;  340 1363-1369
  • 39 Verder H, Robertson B, Greisen G. Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. Danish-Swedish Multicenter Study Group.  N Engl J Med . 1994;  331 1051-1055
  • 40 Verder H, Albertsen P, Ebbesen F. Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks' gestation.  Pediatrics . 1999;  103 E24
  • 41 Jobe A, Ikegami M. Surfactant for the treatment of respiratory distress syndrome.  Am Rev Respir Dis . 1987;  136 1256-1275
  • 42 Adams F, Fujiwara T, Emmanouilides G, Raiha N. Lung phospholipids of human fetuses and infants with and without hyaline membrane disease.  J Pediatr . 1970;  77 833-841
  • 43 Hallman M, Merritt T, Pohjavuori M, Gluck L. Effect of surfactant substitution on lung effluent phospholipids in respiratory distrss syndrome: evaluation of surfactant phospholipid turnover, pool size, and the relationship to severity of respiratory failure.  Pediatr Res . 1986;  20 1228-1235
  • 44 Hildebran J, Goerke J, Clements J. Surfactant release in excised rat lung is stimulated by air inflation.  J Appl Physiol . 1981;  51 905-910
  • 45 Lawson E, Brown E, Torday J, Madansky D, Taeusch H J. The effect of epinephrine on tracheal fluid flow and surfactant efflux in fetal sheep.  Am Rev Respir Dis . 1978;  118 1023-1026
  • 46 Jobe A, Ikegami M, Seidner S, Pettenazzo A, Ruffini L. Surfactant phosphatidylcholine metabolism and surfactant function in preterm, ventilated lambs.  Am Rev Respir Dis . 1989;  139 352-359
  • 47 Ikegami M, Jobe A, Yamada T. Surfactant metabolism in surfactant-treated preterm ventilated lambs.  J Appl Physiol . 1989;  67 429-437
  • 48 Ikegami M, Jobe A. Surfactant metabolism.  Semin Perinatol . 1993;  17 233-240
  • 49 Dunn M, Shennan A, Possmayer F. Single- versus multiple-dose surfactant replacement therapy in neonates of 30 to 36 weeks' gestation with respiratory distress syndrome.  Pediatrics . 1990;  86 564-571
  • 50 Ueda T, Ikegami M, Rider E, Jobe A. Distribution of surfactant and ventilation in surfactant-treated preterm lambs.  J Appl Physiol . 1994;  76 45-55
  • 51 Henry M, Rebello C, Ikegami M, Jobe A, Langenback E, Davis J. Ultrasonic nebulized in comparison with instilled surfactant treatment of preterm lambs.  Am J Respir Crit Care Med . 1996;  154 366-375
  • 52 Dijk P, Heikamp A, Oetomo S. Surfactant nebulization versus instillation during high frequency ventilation in surfactant-deficient rabbits.  Pediatr Res . 1998;  44 699-704
  • 53 Lewis J, Ikegami M, Jobe A, Absolom D. Physiologic responses and distribution of aerosolized surfactant (Survanta) in a nonuniform pattern of lung injury.  Am Rev Respir Dis . 1993;  147 1364-1370
  • 54 Cochrane C, Revak S, Merritt T. Bronchoalveolar lavage with KL4-surfactant in models of meconium aspiration syndrome.  Pediatr Res . 1998;  44 705-715
  • 55 Ikegami M, Jobe A, Berry D. A protein that inhibits surfactant in respiratory distress syndrome.  Biol Neonate . 1986;  50 121-129
  • 56 Ikegami M, Ueda T, Absolom D, Baxter C, Rider E, Jobe A. Changes in exogenous surfactant in ventilated preterm lamb lungs.  Am Rev Respir Dis . 1993;  148 837-844
  • 57 Wada K, Jobe A, Ikegami M. Tidal volume effects on surfactant treatment responses with the initiation of ventilation in preterm lambs.  J Appl Physiol . 1997;  83 1054-1061
  • 58 Ikegami M, Kallapur S, Michna J, Jobe A H. Lung injury and surfactant metabolism following hyperventilation of premature lambs.  Pediatr Res . 2000;  47 398-404
  • 59 Higuchi R, Lewis J, Ikegami M. In vitro conversion of surfactant subtypes is altered in alveolar surfactant isolated from injured lungs.  Am Rev Respir Dis . 1992;  145 1416-1420
  • 60 Michna J, Jobe A, Ikegami M. Positive end-expiratory pressure preserves surfactant function in preterm lambs.  Am J Respir Crit Care Med . 1999;  160 634-639
  • 61 Froese A, McCulloch P, Sugiura M, Vaclavik S, Possmayer F, Moller F. Optimizing alveolar expansion prolongs the effectiveness of exogenous surfactant therpy in the adult rabbit.  Am Rev Respir Dis . 1993;  148 569-577
  • 62 Gittermann M, Fusch C, Gittermann A, Regazzoni B, Moessinger A. Early nasal continuous positive airway pressure treatment reduces the need for intubation in very low birth weight infants.  Eur J Pediatr . 1997;  156 384-388
  • 63 Lundstorm K. Initial treatment of preterm infants: continuous positive airway pressure or ventilation?.  Eur J Pediatr . 1996;  155(Suppl 2) S25-S29
  • 64 Lindner W, Vossbeck S, Hummler H, Pohlandt F. Delivery room management of extremely low birth weight infants: spontaneous breathing or intubation?.  Pediatrics . 1999;  103 961-967
  • 65 Ikegami M, Wada K, Emerson G, Rebello C, Hernandez R, Jobe A. Effects of ventilation style on surfactant metabolism and treatment response in preterm lambs.  Am J Respir Crit Care Med . 1998;  157 638-644
  • 66 Clark R, Gertsmann D, Null D J, deLemos R. Prospective randomized comparison of high-frequency oscillatory and conventional ventilation in respiratory distress syndrome.  Pediatrics . 1992;  89 5-12
  • 67 Gertsmann D, Minton S, Stoddard R. The Provo multicenter early high-frequency oscillatory ventilation trial: improved pulmonary and clinical outcome in respiratory distress syndrome.  Pediatrics . 1996;  98 1044-1057
  • 68 The HIFI Study Group. High-frequency oscillatory ventilation compared with conventional mechanical ventilation in the treatment of respiratory failure in preterm infants.  N Engl J Med . 1989;  320 88-93
  • 69 Rettwitz-Volk W, Veldman A, Roth B. A prospective, randomized, multicenter trial of high-frequency oscillatory ventilation compared with conventional ventilation in preterm infants with respiratory distress syndrome receiving surfactant.  Pediatr . 1998;  132 249-254
  • 70 Moriette G, Walti H, Salanave B. Prospective randomized multicenter comparison of high-frequency oscillatory ventilation (HFOV) and conventional ventilation (CV) in preterm infants <30 weeks' gestational age (GA) with RDS.  Pediatr Res . 1999;  45 212A
  • 71 Hafner D, Germann P, Hauschke D. Effects of rSP-C surfactant on oxygenation and histology in a rat-lung-lavage model of acute lung injury.  Am J Respir Crit Care Med . 1998;  158 270-278
  • 72 Wiswell T E, Smith R M, Katz L B. Bronchopulmonary segmental lavage with surfaxin (KL-4) surfactant for acute respiratory distress syndrome (ARDS).  Am J Respir Crit Care Med . 1999;  160 1188-1195
  • 73 Wiswell T E, and the surfaxin-lavage for MAS trial group. Bronchoalveolar lavage with dilute surfaxin (KL-4 surfactant) for the management of the meconium aspiration syndrome (MAS).  Pediatr Res . 1999;  45 326A