24/05/2004
Surfactant State of the Art And Future Developments

A symposium titled "Surfactant state of the art and future development" (see highlights) was hold during the 44th Annual Meeting of European Society for Paediatric Research (ESRP). It was an important scientific event because brought together experts from around Europe to discuss some of the latest findings in pulmonary surfactant therapy.

Main matters of discussion were the type, timing and dose of surfactant and the different therapeutic approaches to RDS.

The meeting was opened by Jesus Perez, from Madrid, with the presentation "New surfactant features and future proteins and biophysics".

By a laboratory research, he evidenced the common properties and the major differences between native surfactant, natural surfactant ( for example Poractant alfa, obtained from porcine lung) and synthetic preparations are due to the presence of inhibitors.

Native and natural surfactant have the similar features in the absence of inhibitors while the native one is still more resistant to inhibition than all the assayed clinical formulations. Those data confirm the structure and composition of natural surfactant have reached a high quality and a good level of efficacy; anyway many study must be done to optimised  such relevant compound.

An other interesting report was made by Mats Blennow,  who presented results from his working group in Stockholm. He conducted a trial focused on the role of surfactant therapy to reduce mechanical ventilation (MV).

The study showed a reduction in the need of MV using the INSURE (INtubatio-SURfactant-Extubation) approach to RDS.

These results, as the author outlined, can be reproduced in other patient population confirming the efficacy and safety of this new strategy.

Merran Thomson, from London, presented data from new animal model of BPD  and  prospective multicentre trial performed to try to define the right treatment for each phase of respiratory diseases in preterm babies.

As it's known, there's a progressive changes in structure and vulnerabilities to injury in the lung as gestational age (GA) advances.

Therefore, there must be developed a therapy that prevent such possible lung damages.

A combination of  nCPAP and natural surfactant, Poractant alfa, was tested for the first time.

The results of her studies demonstrate the efficacy of the combined approach in reducing the need for MV. In addition natural surfactant, when given prophylactically, results in a great reduction of mortality and pulmonary air leakage and reduces the incidence of BPD in infants of < 30 week GA.

In details, in infants with a GA of < 28 weeks prophylactic surfactant and nCPAP is recommended while in babies with a GA of 30 weeks and above rescue nCPAP and surfactant is the treatment of choice.

In the intermediate group the situation is less clear-up although  prophylactic surfactant and nCPAP and INSURE appeared to be the treatment to consider.

Concluding remarks were made by Professor Holliday, from Belfast.

In his summing up he outlined the recommended protocol for surfactant is depending on GA.

In preterm babies with a GA of 27-28 weeks, prophylaxis with a natural surfactant is recommended (110mg/Kg the dose). In those of 29-31 weeks GA, early nCPAP with early rescue with natural surfactant (100mg/kg the dose) is the recommended treatment of choice, while observation is advised initially in babies >32 weeks GA with surfactant treatment when more than 40% oxygen is needed (see Table).

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