Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany.
Division of Neonatology, Department of Women's and Children's Health, University of Leipzig Medical Center, Leipzig, Germany.
Neonatology. 2021;118(2):225-234. doi: 10.1159/000516106. Epub 2021 May 10.
Surfactant replacement therapy (SRT) has long become the standard of care in the treatment of neonatal respiratory distress syndrome (RDS), significantly decreasing acute pulmonary morbidity and mortality in preterm infants. For decades, this beneficial replacement therapy has been administered via endotracheal tube. Despite significantly improving the outcome of RDS, however, the burden of bronchopulmonary dysplasia remains, in particular, in very immature preterm infants. Acknowledging the direct relationship between exposure to and duration of invasive mechanical ventilation and chronic lung disease, the latter has been gradually replaced by noninvasive ventilation strategies in neonatal RDS. This replacement is strongly related to the demand for similarly noninvasive modes of surfactant administration. Alternative techniques in spontaneously breathing infants have evolved, including less invasive techniques using thin catheters (less invasive surfactant administration and minimally invasive surfactant treatment) as well as nebulization of surfactant, although the latter is not ready for clinical application yet. In addition, given their therapeutic delivery to the lungs and subsequent alveolar distribution, surfactant preparations represent an attractive vehicle for pulmonary deposition of drugs in preterm infants. Further improvement of SRT and expansion of the field of application of lung surfactant may hold additional benefits, especially in the treatment of the most immature preterm infants.
表面活性物质替代疗法（SRT）长期以来一直是治疗新生儿呼吸窘迫综合征（RDS）的标准治疗方法，显著降低了早产儿的急性肺部发病率和死亡率。几十年来，这种有益的替代疗法一直通过气管内管给药。然而，尽管这种治疗显著改善了 RDS 的预后，但支气管肺发育不良的负担仍然存在，特别是在非常不成熟的早产儿中。鉴于与有创机械通气的暴露和持续时间之间存在直接关系，慢性肺部疾病的发病率逐渐被新生儿 RDS 的无创通气策略所取代。这种替代与对同样非侵入性的表面活性剂给药方式的需求密切相关。在自主呼吸的婴儿中，替代技术不断发展，包括使用细导管的微创技术（微创表面活性剂给药和微创表面活性剂治疗）以及表面活性剂的雾化，尽管后者尚未准备好用于临床应用。此外，由于它们向肺部的治疗输送和随后的肺泡分布，表面活性剂制剂代表了向早产儿肺部递药的有吸引力的载体。进一步改善 SRT 和扩大肺表面活性剂的应用领域可能会带来额外的益处，特别是在治疗最不成熟的早产儿方面。
