History

Respiratory distress syndrome frequently occurs in the following individuals:

White male infants
Infants born to mothers with diabetes
Infants born by means of cesarean delivery
Second-born twins
Infants with a family history of respiratory distress syndrome

In contrast, the incidence of respiratory distress syndrome decreases with the following:

Use of antenatal steroids
Pregnancy-induced or chronic maternal hypertension
Prolonged rupture of membranes
Maternal narcotic addiction

Secondary surfactant deficiency may occur in infants with the following:

Intrapartum asphyxia
Pulmonary infections (eg, group B beta-hemolytic streptococcal pneumonia)
Pulmonary hemorrhage
Meconium aspiration pneumonia
Oxygen toxicity along with barotrauma or volutrauma to the lungs
Congenital diaphragmatic hernia and pulmonary hypoplasia

Physical Examination

Physical findings are consistent with the infant's maturity assessed by using the Dubowitz examination or its modification by Ballard.

Progressive signs of respiratory distress are noted soon after birth and include the following:

Tachypnea
Expiratory grunting (from partial closure of glottis)
Subcostal and intercostal retractions
Cyanosis
Nasal flaring
Extremely immature in neonates may develop apnea and/or hypothermia.

Differential Diagnoses

Serrano AG, Ryan M, Weaver TE, et al. Critical structure-function determinants within the N-terminal region of pulmonary surfactant protein SP-B. Biophys J. 2006 Jan 1. 90(1):238-49. [Medline].
Shulenin S, Nogee LM, Annilo T, et al. ABCA3 gene mutations in newborns with fatal surfactant deficiency. N Engl J Med. 2004 Mar 25. 350(13):1296-303. [Medline].
Gerten KA, Coonrod DV, Bay RC, et al. Cesarean delivery and respiratory distress syndrome: does labor make a difference?. Am J Obstet Gynecol. 2005 Sep. 193(3 Pt 2):1061-4. [Medline].
Qiu X, Lee SK, Tan K, et al, for the Canadian Neonatal Network. Comparison of singleton and multiple-birth outcomes of infants born at or before 32 weeks of gestation. Obstet Gynecol. 2008 Feb. 111(2 Pt 1):365-71. [Medline].
Hintz SR, Van Meurs KP, Perritt R, et al, for the NICHD Neonatal Research Network. Neurodevelopmental outcomes of premature infants with severe respiratory failure enrolled in a randomized controlled trial of inhaled nitric oxide. J Pediatr. 2007 Jul. 151(1):16-22, 22.e1-3. [Medline]. [Full Text].
Fanaroff AA, Stoll BJ, Wright LL, et al, for the NICHD Neonatal Research Network. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol. 2007 Feb. 196(2):147.e1-8. [Medline].
Kaufman D, Boyle R, Hazen KC, Patrie JT, Robinson M, Donowitz LG. Fluconazole prophylaxis against fungal colonization and infection in preterm infants. N Engl J Med. 2001 Dec 6. 345(23):1660-6. [Medline]. [Full Text].
Ohlsson A, Walia R, Shah S. Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrance Database Syst Rev. Jan 2008. 23:CD003481. [Medline].
Su PH, Chen JY. Inhaled nitric oxide in the management of preterm infants with severe respiratory failure. J Perinatol. 2008 Feb. 28(2):112-6. [Medline]. [Full Text].
Darlow BA, Ells AL, Gilbert CE, Gole GA, Quinn GE. Are we there yet? Bevacizumab therapy for retinopathy of prematurity. Arch Dis Child Fetal Neonatal Ed. 2013 Mar. 98(2):F170-4. [Medline].
Sun H, Zhou Y, Xiong H, et al. Prognosis of very preterm infants with severe respiratory distress syndrome receiving mechanical ventilation. Lung. 2015 Apr. 193(2):249-54. [Medline].
Billman GF, Hughes AB, Dudell GG, et al. Clinical performance of an in-line, ex vivo point-of-care monitor: a multicenter study. Clin Chem. 2002 Nov. 48(11):2030-43. [Medline].
Gupta S, Sinha SK, Tin W, Donn SM. A randomized controlled trial of post-extubation bubble continuous positive airway pressure versus Infant Flow Driver continuous positive airway pressure in preterm infants with respiratory distress syndrome. J Pediatr. 2009 May. 154 (5):645-50. [Medline].
De Paoli AG, Davis PG, Faber B, Morley CJ. Devices and pressure sources for administration of nasal continuous positive airway pressure (NCPAP) in preterm neonates. Cochrane Database Syst Rev. 2008 Jan 23. CD002977. [Medline].
Manandhar SR. Outcome of respiratory distress in neonates with bubble CPAP at neonatal intensive care unit of a tertiary hospital. JNMA J Nepal Med Assoc. 2019 Mar-Apr. 57(216):92-7. [Medline].
Patry C, Hien S, Demirakca S, et al. Adjunctive therapies for treatment of severe respiratory failure in newborns. Klin Padiatr. 2015 Jan. 227(1):28-32. [Medline].
Crowther CA, Haslam RR, Hiller JE, et al, for the Australasian Collaborative Trial of Repeat Doses of Steroids (ACTORDS) Study Group. Neonatal respiratory distress syndrome after repeat exposure to antenatal corticosteroids: a randomised controlled trial. Lancet. June 2006. 367:1913-9. [Medline].
Doyle LW, Davis PG, Morley CJ, et al, for the DART Study Investigators. Outcome at 2 years of age of infants from the DART study: a multicenter, international, randomized, controlled trial of low-dose dexamethasone. Pediatrics. 2007 Apr. 119(4):716-21. [Medline].
Lin YJ, Lin CH, Wu JM, et al. The effects of early postnatal dexamethasone therapy on pulmonary outcome in premature infants with respiratory distress syndrome: a two-year follow-up study. Acta Paediatr. 2005 Mar. 94(3):310-6. [Medline].
Peaceman AM, Bajaj K, Kumar P, et al. The interval between a single course of antenatal steroids and delivery and its association with neonatal outcomes. Am J Obstet Gynecol. 2005 Sep. 193(3 Pt 2):1165-9. [Medline].
Pesonen AK, Raikkonen K, Lano A, et al. Antenatal betamethasone and fetal growth in prematurely born children: implications for temperament traits at the age of 2 years. Pediatrics. 2009 Jan. 123(1):e31-7. [Medline].
Ring AM, Garland JS, Stafeil BR, et al. The effect of a prolonged time interval between antenatal corticosteroid administration and delivery on outcomes in preterm neonates: a cohort study. Am J Obstet Gynecol. May 2007. 196:1-6. [Medline].
Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. July 2006. 3:CD004454. [Medline].
Wapner RJ, Sorokin Y, Thom EA, et al, for the National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network. Single versus weekly courses of antenatal corticosteroids: evaluation of safety and efficacy. Am J Obstet Gynecol. 2006. 195:633-42. [Medline].
Murphy KE, Hannah ME, Willan AR, et al, for the MACS Collaborative Group. Multiple courses of antenatal corticosteroids for preterm birth (MACS): a randomised controlled trial. Lancet. Dec 2008. 372:2143-51. [Medline].
Porto AM, Coutinho IC, Correia JB, Amorim MM. Effectiveness of antenatal corticosteroids in reducing respiratory disorders in late preterm infants: randomised clinical trial. BMJ. 2011 Apr 12. 342:d1696. [Medline]. [Full Text].
Wapner RJ, Sorokin Y, Mele L, et al, for the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Long-term outcomes after repeat doses of antenatal corticosteroids. New England Journal of Medicine. 2007. 357:1190-8. [Medline]. [Full Text].
Crowther CA, Doyle LW, Haslam RR, et al, for the ACTORDS Study Group. Outcomes at 2 years of age after repeat doses of antenatal corticosteroids. N Engl J Med. 2007. 357:1179-89. [Medline]. [Full Text].
Carlo WA, McDonald SA, Fanaroff AA, et al, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation. JAMA. 2011 Dec 7. 306(21):2348-58. [Medline]. [Full Text].
Engle WA, American Academy of Pediatrics Committee on Fetus and Newborn. Surfactant-replacement therapy for respiratory distress in the preterm and term neonate. Pediatrics. 2008 Feb. 121(2):419-32. [Medline].
Katz LA, Klein JM. Repeat surfactant therapy for postsurfactant slump. J Perinatol. 2006 Jul. 26(7):414-22. [Medline]. [Full Text].
Rojas MA, Lozano JM, Rojas MX, et al, for the Colombian Neonatal Research Network. Very early surfactant without mandatory ventilation in premature infants treated with early continuous positive airway pressure: a randomized, controlled trial. Pediatrics. 2009 Jan. 123(1):137-42. [Medline].
Turker G, Koksal N. Complement 4 levels as early predictors of poor response to surfactant therapy in respiratory distress syndrome. Am J Perinatol. 2005 Apr. 22(3):149-54. [Medline].
Fuchs H, Lindner W, Leiprecht A, Mendler MR, Hummler HD. Predictors of early nasal CPAP failure and effects of various intubation criteria on the rate of mechanical ventilation in preterm infants of Arch Dis Child Fetal Neonatal Ed</i>. 2011 Sep. 96(5):F343-7. [Medline].
Stevens TP, Blennow M, Soll RF. Early surfactant administration with brief ventilation vs selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Syst Rev. 2004. CD003063. [Medline].
Reininger A, Khalak R, Kendig JW, et al. Surfactant administration by transient intubation in infants 29 to 35 weeks' gestation with respiratory distress syndrome decreases the likelihood of later mechanical ventilation: a randomized controlled trial. J Perinatol. 2005 Nov. 25(11):703-8. [Medline].
Olivier F, Nadeau S, Belanger S, et al. Efficacy of minimally invasive surfactant therapy in moderate and late preterm infants: A multicentre randomized control trial. Paediatr Child Health. 2017 Jun. 22(3):120-4. [Medline]. [Full Text].
Kahn DJ, Courtney SE, Steele AM, Habib RH. Unpredictability of delivered bubble nasal continuous positive airway pressure: role of bias flow magnitude and nares-prong air leaks. Pediatr Res. Sept 2007. 62:343-7. [Medline]. [Full Text].
Notter RH. Lung surfactants: basic science and clinical applications. Lung Biology in Health and Disease. Boca Raton, Fl: CRC Press; 2000. Vol 149: 7-344.
Kresch MJ, Lin WH, Thrall RS. Surfactant replacement therapy. Thorax. 1996 Nov. 51(11):1137-54. [Medline].
Laughon M, Bose C, Moya F, et al, for the Surfaxin Study Group. A pilot randomized, controlled trial of later treatment with a peptide-containing, synthetic surfactant for the prevention of bronchopulmonary dysplasia. Pediatrics. 2009 Jan. 123(1):89-96. [Medline].
Malloy CA, Nicoski P, Muraskas JK. A randomized trial comparing beractant and poractant treatment in neonatal respiratory distress syndrome. Acta Paediatr. 2005 Jun. 94(6):779-84. [Medline].
Moya F, Maturana A. Animal-derived surfactants versus past and current synthetic surfactants: current status. Clin Perinatol. 2007 Mar. 34(1):145-77, viii. [Medline].
Moya F, Sinha S, Gadzinowski J, et al, for the SELECT and STAR Study Investigators. One-year follow-up of very preterm infants who received lucinactant for prevention of respiratory distress syndrome: results from 2 multicenter randomized, controlled trials. Pediatrics. 2007 Jun. 119(6):e1361-70. [Medline].
Pfister RH, Soll RF, Wiswell T. Protein containing synthetic surfactant versus animal derived surfactant extract for the prevention and treatment of respiratory distress syndrome. Cochrane Database Syst Rev. 2007 Oct 17. 4:CD006069. [Medline].
Sinha SK, Lacaze-Masmonteil T, Valls i Soler A, et al, for the Surfaxin Therapy Against Respiratory Distress Syndrome Collaborative Group. A multicenter, randomized, controlled trial of lucinactant versus poractant alfa among very premature infants at high risk for respiratory distress syndrome. Pediatrics. 2005 Apr. 115(4):1030-8. [Medline].
Moya FR, Gadzinowski J, Bancalari E, et al, for the International Surfaxin Collaborative Study Group. A multicenter, randomized, masked, comparison trial of lucinactant, colfosceril palmitate, and beractant for the prevention of respiratory distress syndrome among very preterm infants. Pediatrics. 2005 Apr. 115(4):1018-29. [Medline].
Kinniry P, Pick J, Stephens S, et al. KL4-surfactant prevents hyperoxic and LPS-induced lung injury in mice. Pediatr Pulmonol. 2006 Oct. 41(10):916-28. [Medline].
Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK. Treatment of the idiopathic respiratory-distress syndrome with continuous positive airway pressure. N Engl J Med. 1971 Jun 17. 284(24):1333-40. [Medline].
Ammari A, Suri M, Milisavljevic V, et al. Variables associated with the early failure of nasal CPAP in very low birth weight infants. J Pediatr. 2005 Sep. 147(3):341-7. [Medline].
Murray PG, Stewart MJ. Use of nasal continuous positive airway pressure during retrieval of neonates with acute respiratory distress. Pediatrics. 2008 Apr. 121(4):e754-8. [Medline].
Wells DA, Gillies D, Fitzgerald DA. Positioning for acute respiratory distress in hospitalised infants and children. Cochrane Database Syst Rev. 2005. CD003645. [Medline].
Stack JA, Jalaludin B. Developmental outcomes at the age of two years for very premature babies managed with nasal prong continuous positive airway pressure. J Paediatr Child Health. 2007 Jun. 43(6):480-5. [Medline].
Subramaniam P, Henderson-Smart DJ, Davis PG. Prophylactic nasal continuous positive airways pressure for preventing morbidity and mortality in very preterm infants. Cochrane Database Syst Rev. July 2005. 20:CD001243. [Medline].
Booth C, Premkumar MH, Yannoulis A, et al. Sustainable use of continuous positive airway pressure in extremely preterm infants during the first week after delivery. Arch Dis Child Fetal Neonatal Ed. Nov 2006. 91:398-402. [Medline]. [Full Text].
Morley CJ, Davis PG, Doyle LW, et al, for the COIN Trial Investigators. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med. 2008 Feb 14. 358(7):700-8. [Medline]. [Full Text].
Narendran V, Donovan EF, Hoath SB, Akinbi HT, Steichen JJ, Jobe AH. Early bubble CPAP and outcomes in ELBW preterm infants. J Perinatol. 2003 Apr-May. 23(3):195-9. [Medline]. [Full Text].
Lampland AL, Plumm B, Worwa C, Meyers P, Mammel MC. Bi-level CPAP does not improve gas exchange when compared with conventional CPAP for the treatment of neonates recovering from respiratory distress syndrome. Arch Dis Child Fetal Neonatal Ed. 2015 Jan. 100(1):F31-4. [Medline].
Armfield M, West G. Use of Vapotherm for respiratory support with neonates. Paediatr Nurs. 2009 Feb. 21(1):27-30. [Medline].
Holleman-Duray D, Kaupie D, Weiss MG. Heated humidified high-flow nasal cannula: use and a neonatal early extubation protocol. J Perinatol. 2007 Dec. 27(12):776-81. [Medline]. [Full Text].
Kirby R, Robison E, Schulz J, DeLemos RA. Continuous-flow ventilation as an alternative to assisted or controlled ventilation in infants. Anesth Analg. 1972 Nov-Dec. 51(6):871-5. [Medline].
D'Angio CT, Chess PR, Kovacs SJ, et al. Pressure-regulated volume control ventilation vs synchronized intermittent mandatory ventilation for very low-birth-weight infants: a randomized controlled trial. Arch Pediatr Adolesc Med. 2005 Sep. 159(9):868-75. [Medline].
Truffert P, Paris-Llado J, Escande B, et al. Neuromotor outcome at 2 years of very preterm infants who were treated with high-frequency oscillatory ventilation or conventional ventilation for neonatal respiratory distress syndrome. Pediatrics. 2007 Apr. 119(4):e860-5. [Medline].
Field D, Elbourne D, Truesdale A, et al, for the INNOVO Trial Collaborating Group. Neonatal ventilation with inhaled nitric oxide versus ventilatory support without inhaled nitric oxide for preterm infants with severe respiratory failure: the INNOVO multicentre randomised controlled trial (ISRCTN 17821339). Pediatrics. 2005 Apr. 115(4):926-36. [Medline].
Kinsella JP, Abman SH. Inhaled nitric oxide in the premature newborn. J Pediatr. 2007 Jul. 151(1):10-5. [Medline].
Schreiber MD, Marks JD. No definitive recommendation for iNO in preterm infants. J Pediatr. 2006 Jul. 149(1):146-7; author reply 147. [Medline].
Van Meurs KP, Hintz SR, Ehrenkranz RA, et al. Inhaled nitric oxide in infants >1500 g and J Perinatol</i>. 2007 Jun. 27(6):347-52. [Medline].
Ballard RA, Truog WE, Cnaan A, et al, for the NO CLD Study Group. Inhaled nitric oxide in preterm infants undergoing mechanical ventilation. N Engl J Med. 2006 Jul 27. 355(4):343-53. [Medline]. [Full Text].
Kinsella JP. Inhaled nitric oxide in the term newborn. Early Hum Dev. 2008 Nov. 84(11):709-16. [Medline].
[Guideline] Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome - 2019 update. Neonatology. 2019. 115(4):432-50. [Medline]. [Full Text].
Ahmed SJ, Rich W, Finer NN. The effect of averaging time on oximetry values in the premature infant. Pediatrics. 2010 Jan. 125(1):e115-21. [Medline].
Claure N, Bancalari E, D'Ugard C, et al. Multicenter crossover study of automated control of inspired oxygen in ventilated preterm infants. Pediatrics. 2011 Jan. 127(1):e76-83. [Medline].
Courtney SE, Kahn DJ, Singh R, Habib RH. Bubble and ventilator-derived nasal continuous positive airway pressure in premature infants: work of breathing and gas exchange. J Perinatol. 2011 Jan. 31(1):44-50. [Medline].
Dumpa V, Northrup V, Bhandari V. Type and timing of ventilation in the first postnatal week is associated with bronchopulmonary dysplasia/death. Am J Perinatol. 2011 Apr. 28(4):321-30. [Medline].
Finer NN, Carlo WA, Walsh MC, et al. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med. 2010 May 27. 362(21):1970-9. [Medline]. [Full Text].
Jatana KR, Oplatek A, Stein M, Phillips G, Kang DR, Elmaraghy CA. Effects of nasal continuous positive airway pressure and cannula use in the neonatal intensive care unit setting. Arch Otolaryngol Head Neck Surg. 2010 Mar. 136(3):287-91. [Medline]. [Full Text].
Kugelman A, Feferkorn I, Riskin A, Chistyakov I, Kaufman B, Bader D. Nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure for respiratory distress syndrome: a randomized, controlled, prospective study. J Pediatr. 2007 May. 150(5):521-6, 526.e1. [Medline].
Morley CJ, Davis PG, Doyle LW, et al, for the COIN Trial Investigators. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med. 2008 Feb 14. 358(7):700-8. [Medline]. [Full Text].
Singh J, Sinha SK, Alsop E, Gupta S, Mishra A, Donn SM. Long term follow-up of very low birthweight infants from a neonatal volume versus pressure mechanical ventilation trial. Arch Dis Child Fetal Neonatal Ed. 2009 Sep. 94(5):F360-2. [Medline].
Walsh MC, Hibbs AM, Martin CR, et al, for the NO CLD Study Group*. Two-year neurodevelopmental outcomes of ventilated preterm infants treated with inhaled nitric oxide. J Pediatr. 2010 Apr. 156(4):556-61.e1. [Medline]. [Full Text].
Li G, Zhang L, Sun Y, Chen J, Zhou C. Co-initiation of continuous renal replacement therapy, peritoneal dialysis, and extracorporeal membrane oxygenation in neonatal life-threatening hyaline membrane disease: A case report. Medicine (Baltimore). 2019 Jan. 98(4):e14194. [Medline]. [Full Text].

Media Gallery

Chest radiographs in a premature infant with respiratory distress syndrome before and after surfactant treatment. Left: Initial radiograph shows poor lung expansion, air bronchogram, and reticular granular appearance. Right: Repeat chest radiograph obtained when the neonate is aged 3 hours and after surfactant therapy demonstrates marked improvement.
Microscopic appearance of lungs of an infant with respiratory distress syndrome. Hematoxylin and eosin stain shows hyaline membranes (pink areas).
Schematic outlines the pathology of respiratory distress syndrome (RDS). Infants may recover completely or develop chronic lung damage, resulting in bronchopulmonary dysplasia (BPD). FiO2 = fraction of inspired oxygen; HMD = hyaline membrane disease; V/Q = ventilation perfusion.
Bar chart demonstrates the composition of lung surfactant. About 1% of the 10% protein component comprises surfactant apoproteins; the remaining proteins are derived from alveolar exudate.
Schematic show surfactant metabolism, with a single alveolus is shown and the location and movement of surfactant components. Surfactant components are synthesized from precursors in the endoplasmic reticulum and transported through the Golgi apparatus by multivesicular bodies. Components are ultimately packaged in lamellar bodies, which are intracellular storage granules for surfactant before its secretion. After secretion (exocytosis) into the liquid lining of the alveolus, surfactant phospholipids are organized into a complex lattice called tubular myelin. Tubular myelin is believed to generate the phospholipid that provides material for a monolayer at the air-liquid interface in the alveolus, which lowers surface tension. Surfactant phospholipids and proteins are subsequently taken back into type II cells, in the form of small vesicles, apparently by a specific pathway that involves endosomes, and then are transported for storage into lamellar bodies for recycling. Alveolar macrophages also take up some surfactant in the liquid layer. A single transit of the phospholipid components of surfactant through the alveolar lumen normally requires a few hours. The phospholipid in the lumen is taken back into type II cell and is reused 10 times before being degraded. Surfactant proteins are synthesized in polyribosomes and extensively modified in the endoplasmic reticulum, Golgi apparatus, and multivesicular bodies. Surfactant proteins are detected in lamellar bodies or secretory vesicles closely associated with lamellar bodies before they are secreted into the alveolus.
Bottom curve reflects findings from lungs obtained at postmortem from an infant with hyaline membrane disease (HMD). Lungs with HMD require far more pressure than to achieve a given volume of inflation than do lungs obtained from an infant dying of a nonrespiratory cause. Arrows indicate inspiratory and expiratory limbs of the pressure-volume curves. Note the decreased lung compliance and increased critical opening and closing pressures, respectively, in the premature infant with HMD.
Effects of early treatment with low-dose inhaled nitric oxide (iNO) on brain injury (ie, grade 3-4 intracranial hemorrhage [ICH], periventricular leukomalacia [PVL], ventriculomegaly) in premature infants according to birth weight strata. iNO reduced ultrasonography findings of brain injury for the overall group (n = 793), with the largest effect in the 750-g to 999-g group (n = 280). Control = □; iNO = ■.
Effects of early treatment of preterm infants with low-dose inhaled nitric oxide (iNO) on bronchopulmonary dysplasia (BPD) incidence by birth weight strata. No difference in reduction was reported in infants weighing less than 1000 g (n = 129). Control = □; iNO = ■.
Effects of inhaled nitric oxide (iNO) survival without bronchopulmonary dysplasia (BPD) for infants aged 7-21 days. iNO increased survival without BPD in infants who were treated before age 14 days (n = 727).
Assisted ventilation newborn –Intubation and meconium aspiration. Video courtesy of Therese Canares, MD, and Jonathan Valente, MD, Rhode Island Hospital, Brown University.

of 10

Outcome	Number of Trials	Relative Risk (95% CI)	Relative Difference (95% CI)
Pneumothorax	3	0.70 (0.59, 0.82)	-5.2% (-7.5%, -2.9%)
Bronchopulmonary dysplasia (BPD)	3	0.97 (0.88, 1.06)	-1.2% (-4.6%, 2.2%)
Mortality	4	0.87 (0.77, 0.99)	-2.8% (-5.5%, 0.0%)
BPD or death	3	0.94 (0.88, 1.00)	-3.7% (-7.2%, 0.0%)

Type	Source	Composition	Dosing	Comments
Beractant (Survanta)	Bovine lung mince	Dipalmitoyl phosphatidylcholine (DPPC), tripalmitin, SP-B < 0.5%, SP-C 99% of TP wt/wt	4mL/kg (100mg/kg), 1-4 doses every 6h	Refrigerate
Surfactant-TA (Surfacten)	Bovine lung mince		4mL/kg (100mg/kg), 1-4 doses every 6h	Refrigerate
Bovactant (Alveofact)	Bovine lung lavage	99% PL, 1% SP-B and SP-C	45mg/mL	From the Federal Republic of Germany
Bovine lipid extract surfactant (bLES)	Bovine lung lavage	75% phosphatidylcholine (PC) and 1% SP-B and SP-C	135mg/kg/dose (5mL/kg), 1-4 doses every 12h	Canadian
Infasurf	Calf lung lavage	DPPC, tripalmitin, SP-B 290g/mL, SP-C 360g/mL	3mL/kg (105mg/kg), 1-4 doses every 6-12h	6mL vials, refrigerate
Calf lung surfactant extract (CLSE)	Similar to Infasurf
Poractant alpha (Curosurf)	Minced pig lung	Phospholipids (DPPC, phosphatidylglycerol [PG]), neutral lipids, fatty acids; SP-B and SP-C; 80mg/mL of PL/mL [54mg PC (30.5mg DPPC and 1mg protein includes 0.3mg of SP-B)]	Initially 2.5mL/kg (200mg/kg), followed by 1.25mL (100mg)/kg	1.5 and 3mL
Colfosceril palmitate (Exosurf)	Synthetic	85% DPPC, 9% hexadecanol, 6% tyloxapol	5mL/kg (67.5mg/kg), 1-4 doses every 12h	No longer available; lyophilized, dissolve in 8mL
Lucinactant (Surfaxin)	Synthetic	Protein: KL4 (sinapultide) resembles SP-B; Phospholipids: DPPC, palmitoyloleoyl phosphatidylcholine (POPG)	175 mg/kg/dose phospholipid	FDA-approved March 2012; warmed for 15min at 44°C on a heating block, followed by vigorous shaking until a uniform, free-flowing suspension forms
Artificial lung expanding compound (ALEC)	Synthetic	70% DPPC, 30% unsaturated phosphatidylglycerol	No data	Discontinued

	Natural Surfactant Treatment		Synthetic Surfactant Treatment
Outcome	Number of Trials	Relative Risk (95% Confidence Interval [CI]) Relative Difference (95% CI)	Number of Trials	Relative Risk (95% CI) Relative Difference (95% CI)
Pneumothorax	12	0.43 (0.35, 0.52) -17% (-21%, -13%)	5	0.64 (0.55, 0.76) -9% (-12%, -6%)
Bronchopulmonary dysplasia (BPD)	9	0.94 (0.72, 1.22) -2% (-9%, 4%)	5	0.75 (0.61, 0.92) -4% (-6%, -1%)
Mortality	12	0.68 (0.57, 0.80) -9% (-13%, -5%)	6	0.73 (0.61, 0.88) -5% (-7%, -2%)
BPD or death	10	0.76 (0.65, 0.90) -14% (-21%, -7%)	4	0.73 (0.65, 0.83) -8% (-11%, -5%)

	Natural Prophylaxis		Synthetic Prophylaxis
Outcome	Number of Trials	Relative Risk (95% CI) Relative Difference (95% CI)	Number of Trials	Relative Risk (95% CI) Relative Difference (95% CI)
Pneumothorax	8	0.35 (0.26, 0.49) -13% (-20%, -11%)	6	0.67 (0.50, 0.90) -5% (-9%, -2%)
BPD	7	0.93 (0.80, 1.07) -4% (-9%, -3%)	4	1.06 (0.83, 1.36) 1% (-4%, 6%)
Mortality	7	0.60 (0.44, 0.83) -7% (-12%, -3%)	7	0.70 (0.58, 0.85) -7% (-11%, -3%)
BPD or death	7	0.84 (0.75, 0.93) -10% (-16%, -4%)	4	0.80 (0.77, 1.03) -4% (-10%, 1%)

Outcome	Number of Trials	Relative Risk (95% CI)	Relative Difference (95% CI)
Pneumothorax	5	0.68 (0.56, 0.83)	-4.1% (-6.3%, -2.0%)
BPD	4	0.97 (0.88, 1.07)	-1.2% (-5.4%, -2.9%)
Mortality	7	0.88 (0.76, 1.02)	-2.2% (-4.7%, 0.4%)
BPD or death	2	0.94 (0.87, 1.01)	-3.6% (-8.0%, 0.8%)

Respiratory Distress Syndrome Clinical Presentation

History

Physical Examination

About

Membership

Apps

WebMD Network

Editions

Study	Number Enrolled	Mean Gestational Age (wk)	Mean Birth Weight (g)	Mean Oxygen Index	Placebo Death Rate	Therapy Duration (d)	Maximum Dose	% Change in Death/BPD
Kinsella et al^[65]	80	27	1000	30	53%	7	5 ppm	-15%
Schreiber et al^[66]	201	27.2	970	10	22.5%	7	10 ppm	-15%
Van Meurs et al^[67]	420	26	839	22	44%	3	10 ppm	-2%
Ballard et al^[68]	587	26	760	7	6%	24	20 ppm	-11%
Kinsella et al^[69]	793	25	792	5	25%	14	5 ppm	-4%

Outcome	Number of Trials	Relative Risk (95% CI)	Relative Difference (95% CI)
Pneumothorax	6	0.62 (0.42, 0.89)	-2.1% (-3.7%, -0.55)
BPD	7	0.95 (0.81, 1.11)	-0.9% (-3.5%, 1.7%)
Mortality	6	0.59 (0.46, 0.76)	-4.6% (-6.8%, -2.5%)
BPD or death	7	0.85 (0.76, 0.95)	-4.5% (-7.4%, -1.5%)
Infants < 30 wk of gestation
Mortality	6	0.60 (0.47, 0.77)	-6.5% (-9.6%, -3.4%)
BPD or death	7	0.86 (0.77, 0.96)	-5.5% (-9.6%, -1.5%)

Respiratory Distress Syndrome Clinical Presentation

History

Physical Examination

References

Tables

Contributor Information and Disclosures

What would you like to print?

Find Us On

About

Membership

Apps

WebMD Network

Editions