New methods advance treatment for respiratory distress syndrome.

The past 20 years of hard labor in neonatal respiratory distress have resulted in several important advances arising from our understanding of lung chemistry and physiology. Our knowledge of surfactant chemistry has enabled us to identify infants at high risk for developing neonatal distress due to surfactant deficiency, reducing this risk with antenatal corticosteroid treatment, and improving the neonatal outcome by means of administration of effective surfactant replacement. Recognition of the roles of oxygen toxicity and barotrauma in promoting lung injury has premitted the development of more effective means of assisted ventilation less likely to injure the lungs of severely ill infants with pulmonary failure. Nitric oxide has proven to be an effective pulmonary vasodilator and permits the successful treatment of patients with pulmonary hypertension who might previously have required an invasive surgical treatment to achieve a desirable clinical outcome.