Artificial surfactant to prevent and treat neonatal respiratory distress syndrome

Twenty years ago we were first presented with evidence that infants dying from hyaline membrane disease suffer from a pulmonary surfactant deficiency.1 This observation has been substantiated with numerous reports from several countries. It offers a logical explanation to the physiology and pathology characterizing the condition, and has clearly influenced preventive and therapeutic measures. The obstetrician tries to avoid delivery until surfactant synthesis has become adequate through a naturally occurring process of maturation, or through one stimulated with glucocorticoids, and the pediatrician counteracts the tendency for atelectasis to develop by applying an airway pressure which is continuously distending. Delivery quite often occurs so early in gestation that surfactant synthesis is still inadequate and there has not been sufficient time to stimulate it.