Réanimation et Pédiatrie Néonatales, Groupe Hospitalier Robert Debré, APHP, 48 Bd Sérurier, Paris, 75019, France.
BMC Pediatr. 2013 Oct 10;13:165. doi: 10.1186/1471-2431-13-165.
Surfactant therapy is one of the few treatments that have dramatically changed clinical practice in neonatology. In addition to respiratory distress syndrome (RDS), surfactant deficiency is observed in many other clinical situations in term and preterm infants, raising several questions regarding the use of surfactant therapy.
This review focuses on several points of interest, including some controversial or confusing topics being faced by clinicians together with emerging or innovative concepts and techniques, according to the state of the art and the published literature as of 2013. Surfactant therapy has primarily focused on RDS in the preterm newborn. However, whether this treatment would be of benefit to a more heterogeneous population of infants with lung diseases other than RDS needs to be determined. Early trials have highlighted the benefits of prophylactic surfactant administration to newborns judged to be at risk of developing RDS. In preterm newborns that have undergone prenatal lung maturation with steroids and early treatment with continuous positive airway pressure (CPAP), the criteria for surfactant administration, including the optimal time and the severity of RDS, are still under discussion. Tracheal intubation is no longer systematically done for surfactant administration to newborns. Alternative modes of surfactant administration, including minimally-invasive and aerosolized delivery, could thus allow this treatment to be used in cases of RDS in unstable preterm newborns, in whom the tracheal intubation procedure still poses an ethical and medical challenge.
The optimization of the uses and methods of surfactant administration will be one of the most important challenges in neonatal intensive care in the years to come.
表面活性物质治疗是为数不多的能够显著改变新生儿学临床实践的治疗方法之一。除了呼吸窘迫综合征（RDS）外，在许多足月和早产儿的其他临床情况下也观察到表面活性物质缺乏，这引发了关于表面活性物质治疗应用的几个问题。
本综述重点关注了几个感兴趣的点，包括临床医生面临的一些有争议或令人困惑的问题，以及根据 2013 年的最新技术和已发表的文献提出的新兴或创新概念和技术。表面活性物质治疗主要集中在早产儿的 RDS 上。然而，这种治疗是否对除 RDS 以外的肺部疾病的更异质的婴儿群体有益，还需要确定。早期试验强调了对有发生 RDS风险的新生儿预防性给予表面活性物质的益处。在接受产前肺成熟治疗和持续气道正压通气（CPAP）早期治疗的早产儿中，表面活性物质给药的标准，包括最佳时间和 RDS 的严重程度，仍在讨论中。对于需要给予表面活性物质的新生儿，不再系统地进行气管插管。替代的表面活性物质给药方式，包括微创和雾化给药，因此可以使这种治疗方法用于不稳定的早产儿 RDS 病例，在这些病例中，气管插管程序仍然存在伦理和医学挑战。
表面活性物质给药的使用和方法的优化将是未来几年新生儿重症监护中最重要的挑战之一。
