[Pulmonary surfactant and its clinical application].

The rationale for surfactant replacement therapy (SRT) in preterm neonates with respiratory distress syndrome (RDS) was presented. Findings on the biophysical properties of surfactant preparations based on natural components, including the hydrophobic polypeptides SP-B and SP-C were discussed, along with clinical experience with a reconstituted bovine lung surfactant (Surfactant-TA). Since the first successful clinical use of this surfactant in 1980, a number of subsequent studies have confirmed that SRT can modify the course of RDS. Factors affecting the response to surfactant replacement therapy with Surfactant-TA were also addressed. One controversial issue was the relative effectiveness of prophylactic versus rescue strategies. In our recent prospective randomized trial, prophylactic use of Surfactant-TA prevented the development of RDS completely, and thereby reduced the incidence of chronic lung disease (odds ratio, 0.08 (92% reduction); p = 0.016). This study differed from other similar studies of different surfactants in that only babies with documented surfactant deficiency were included. Our recent in vivo studies showed that Surfactant-TA is Superior to survanta and to totally synthetic surfactants available for clinical use.