Abstract
This review summarizes the current knowledge on the physiological action of endogenous and exogenous pulmonary surfactant, the role of different types of animal-derived and synthetic surfactants for RDS therapy, different modes of administration, potential risks and strategies of ventilation, and highlights the most promising aims for future development. Scientists have clarified the physicochemical properties and functions of the different components of surfactant, and part of this successful research is derived from the characterization of genetic diseases affecting surfactant composition or function. Knowledge from functional tests of surfactant action, its immunochemistry, kinetics and homeostasis are important also for improving therapy with animal-derived surfactant preparations and for the development of modified surfactants. In the past decade newly designed artificial surfactants and additives have gained much attention and have proven different advantages, but their particular role still has to be defined. For clinical practice, alternative administration techniques as well as postsurfactant ventilation modes, taking into account alterations in lung mechanics after surfactant placement, may be important in optimizing the potential of this most important drug in neonatology.
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R.H. framed the review concept, drafted part of the article, compiled all parts of the manuscript, and revised it critically for important intellectual content. K.B. drafted part of the article. A.v.K. drafted part of the article and helped revise the manuscript critically for important intellectual content. H.F. drafted part of the article. O.D. drafted part of the article and revised the manuscript critically for important intellectual content. All authors gave their final approval for this paper for publication.
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Hentschel, R., Bohlin, K., van Kaam, A. et al. Surfactant replacement therapy: from biological basis to current clinical practice. Pediatr Res 88, 176–183 (2020). https://doi.org/10.1038/s41390-020-0750-8
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DOI: https://doi.org/10.1038/s41390-020-0750-8
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