Neonatology in the 1990’s: Surfactant Replacement Therapy Becomes a Reality

It has been more than 35 years since the lung was discovered to be lined with a layer of surface-active material that is important in lung stability and mechanics of respiration.1-4The absence of this "anti-atelectasis " factor2,3 was proposed by Avery and Mead in 1959 to be the cause of hyaline membrane disease of premature infants.5 An indepth historical review of pulmonary surfactant by Tierney 6was recently published. In the years since 1959, there has been an exhaustive amount of research aimed at elucidating the structure and function of pulmonary surfactant, the ultimate goal being a safe and effective exogenous surfactant for the treatment of the Respiratory Distress Syndrome (RDS). The days of surfactant research are far from over, but the era of surfactant replacement therapy is now upon us. The practitioner needs to be knowledgeable about surfactant and aware of his or her role in surfactant therapy for premature infants. The following is intended to clarify some of the important issues of surfactant replacement. Composition and Function of Surfactant Pulmonary surfactant, as recovered from airway washings of mammalian lungs, is a lipoprotein mixture containing 80 % phospholipids, 10 % protein, and 10 % neutral lipid