Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States.
Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California, United States.
Am J Physiol Lung Cell Mol Physiol. 2024 Dec 1;327(6):L883-L889. doi: 10.1152/ajplung.00186.2024. Epub 2024 Oct 15.
Research on lung surfactant has exerted a great impact on newborn respiratory care and significantly improved survival and outcome of preterm infants with respiratory distress syndrome (RDS) due to surfactant deficiency because of lung immaturity. Current clinical, animal-derived, surfactants are among the most widely tested compounds in neonatology. However, limited availability, high production costs, and ethical concerns about using animal-derived products constitute important limitations in their universal application. Synthetic lung surfactant offers a promising alternative to animal-derived surfactants by providing improved consistency, quality and purity, availability and scalability, ease of production and lower costs, acceptance, and safety for the treatment of neonatal RDS and other lung conditions. Third-generation synthetic surfactants built around surfactant protein B (SP-B) and C (SP-C) peptide mimics stand at the forefront of innovation in neonatal pulmonary medicine, while nasal continuous positive airway pressure (nCPAP) has become the standard noninvasive respiratory support for preterm infants. nCPAP can prevent the risk of chronic lung disease (bronchopulmonary dysplasia) and reduce lung injury by avoiding intubation and mechanical ventilation, is a relatively simple technique, and can be initiated safely and effectively in the delivery room. Combining nCPAP with noninvasive, preferably aerosol, delivery of synthetic lung surfactant promises to improve respiratory outcomes for preterm infants, especially in low- and middle-income countries.
肺表面活性剂的研究对新生儿呼吸护理产生了巨大影响，由于肺不成熟导致表面活性物质缺乏，显著改善了呼吸窘迫综合征（RDS）早产儿的生存率和预后。目前，临床使用的、来源于动物的肺表面活性剂是新生儿学中测试最广泛的化合物之一。然而，其广泛应用受到有限的可用性、高生产成本以及使用动物源性产品的伦理问题的限制。合成肺表面活性剂为动物源性肺表面活性剂提供了一种有前途的替代品，具有提高的一致性、质量和纯度、可用性和可扩展性、生产的便利性和更低的成本、接受度和治疗新生儿 RDS 和其他肺部疾病的安全性。以表面活性蛋白 B（SP-B）和 C（SP-C）肽模拟物为基础的第三代合成肺表面活性剂处于新生儿肺医学创新的前沿，而鼻持续气道正压通气（nCPAP）已成为早产儿的标准非侵入性呼吸支持。nCPAP 通过避免插管和机械通气，可以预防慢性肺部疾病（支气管肺发育不良）的风险和减少肺损伤，是一种相对简单的技术，可以在分娩室安全有效地启动。将 nCPAP 与非侵入性、最好是气雾剂的合成肺表面活性剂联合应用有望改善早产儿的呼吸结局，尤其是在中低收入国家。
