Early versus late surfactant treatment in the preterm infants

Background: Neonatal respiratory distress syndrome is a condition of increasing respiratory distress commencing at, or shortly after birth and increasing in severity until progressive resolutions occurs among the survivors, usually between 2nd to 4th day. It is due to insufficiency of pulmonary surfactant and mainly confined to preterm infants. RDS is manifested by respiratory distress (cyanosis, tachypnea, grunting and retraction) and respiratory failure is diagnosed by blood gas analysis. Oedema is frequently seen on the 2nd day due to fluid retention and capillary leak. The diagnosis can be confirmed by X-ray films showing ground glass appearance. RDS is the commonest cause of morbidity and mortality in preterm infants. Treatment of RDS contains many lines but giving surfactant to neonates is the main line of treatment in RDS. Exogenous surfactant therapy has been a significant advance in the management of preterm infants with RDS. It has become established as a standard part of management of such infants lead to clinical improvement and decrease mortality with natural surfactant having additional advantages over currently available synthetic surfactant. Pulmonary surfactant is composed of phosphatidylglycerol. Surfactant is synthetized and secreted by type II epithelial cells in alveolus. Factors affecting surfactant production include glucocorticoids, beta adrenergic drugs and insulin prolactin. Pulmonary surfactant affects the lung mechanisms, gas exchange via its surface tension lowering ability has been studied extensively. Its role in alveolar host defense remains hypothetical. Surfactant can be administrated by different methods which may affect its efficacy. Complications of surfactant use may be procedural complications resulting from administration of surfactant e.g. plugging of endotracheal tube, haemoglobin desaturation and increased due to supplemental oxygen bradycardia due to hypoxia. Physiological complications e.g. apnea and pulmonary hemorrhage. This research included also some knowledge about biochemical composition, types, dose and time of giving surfactant. Surfactnat replacement therapy has been shown to improve clinical outcome whether given prophylactic to infants at risk of RDS or given to infants with established RDS. We evaluate the merits of early selective surfactant treatment compared to delayed selective surfactant treatment in infants with RDS. Early surfactant administration significantly reduces the risk of key clinical outcomes including pneumothorax, PIE, CLD, and neonatal mortality. Early surfactant therapy compared to late therapy leads to reduction of number of days on ventilator and improves survival.Objectives: Aim of the work is to review respiratory distress syndrome in preterm neonates, phatophysiology, surfactant types, time of administration, management and benefits of early surfactant administration in the preterm infants.