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Drugs Today (Barc). 2009 Sep;45(9):697-709. doi: 1396674/dot.2009.45.9.1418185.

Animal-derived surfactant treatment of respiratory distress syndrome in premature neonates: a review.

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Department of Pediatrics, Boston Medical Center, Boston, Massachusetts 02118, USA.


Exogenous surfactant treatment of premature infants with respiratory distress syndrome (RDS) has been the standard of care for the past two decades. There are many studies comparing various surfactant preparations. Data are clear that the synthetic surfactants without surfactant proteins are inferior to animal-derived surfactant preparations. Less compelling are the data regarding the relative efficacy of the various animal-derived surfactants available, but a pattern has evolved favoring surfactant preparations with higher concentrations of phospholipids and surfactant proteins. A higher initial dose of phospholipids may also be important, especially for preterm infants less than 32 weeks of gestation. Development has begun of new synthetic surfactants with surfactant protein analogs or recombinant surfactant proteins, which are not yet available in the United States. Synthetic surfactants hold the possibility of surfactant treatments without potential animal-born infectious agents or animal proteins that could induce an immune response in fragile premature infants with multiple medical problems. The goal of this review is to assess the comparison of available animal-derived surfactants and what is known of their comparison. with the newer synthetic surfactants. In addition, the possible direct and indirect effects of surfactant administration on regional blood flow are discussed, with their potential relationship to the volume of surfactant administered.

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