Published online February 1, 2008
PEDIATRICS Vol. 121 No. 2 February 2008, pp. 419-432 (doi:10.1542/10.1542/peds.2007-3283)
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CLINICAL REPORT

Surfactant-Replacement Therapy for Respiratory Distress in the Preterm and Term Neonate

William A. Engle, MD and the Committee on Fetus and Newborn

Respiratory failure secondary to surfactant deficiency is a major cause of morbidity and mortality in preterm infants. Surfactant therapy substantially reduces mortality and respiratory morbidity for this population. Secondary surfactant deficiency also contributes to acute respiratory morbidity in late-preterm and term neonates with meconium aspiration syndrome, pneumonia/sepsis, and perhaps pulmonary hemorrhage; surfactant replacement may be beneficial for these infants. This statement summarizes indications, administration, formulations, and outcomes for surfactant-replacement therapy. The impact of antenatal steroids and continuous positive airway pressure on outcomes and surfactant use in preterm infants is reviewed. Because respiratory insufficiency may be a component of multiorgan dysfunction, preterm and term infants receiving surfactant-replacement therapy should be managed in facilities with technical and clinical expertise to administer surfactant and provide multisystem support.

Key Words: surfactant • antenatal steroids • respiratory distress syndrome • meconium aspiration syndrome • neonatal pneumonia • neonatal sepsis • congenital diaphragmatic hernia • pulmonary hemorrhage • persistent pulmonary hypertension • preterm • term

Abbreviations: RR—relative risk • CI—confidence interval • NNT—number needed to treat


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The following policy statement has been revised:

Surfactant Replacement Therapy for Respiratory Distress Syndrome

Pediatrics 103: 684-685. [Full Text]



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Surfactant Prophylaxis in the Small but Stable Premature
Steve Piecuch, MD, MPH
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