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December 1988

Surfactant Replacement: A New Era With Many Challenges for Neonatal Medicine

Am J Dis Child. 1988;142(12):1333-1339. doi:10.1001/archpedi.1988.02150120087047

Exogenous surfactant therapy offers great promise for reducing the severity, morbidity, and early mortality attributable to the respiratory distress syndrome (RDS). The RDS remains the primary cause of neonatal mortality; it is responsible for approximately one neonatal death per 1000 live births in the United States,1 and it contributes to the number of infants with chronic pulmonary sequelae and neurodevelopmental handicaps, emphasizing the need to make efficacious therapies available throughout the world. Since 1959, surfactant deficiency has been recognized as primary in the pathogenesis of RDS2; RDS results in progressive atelectasis, ventilatory failure, and combined metabolic and respiratory acidosis, resulting in a "shocklike" state with multiorgan failure. However, RDS, a developmental disorder, is further complicated by neonatal maladaptation to extrauterine life and multiorgan immaturity, including prolonged patency of the ductus arteriosus, poorly regulated cerebral blood flow, gastrointestinal immaturity, limited renal function, and vulnerability to infection. The clinical use