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Surfactant status assessment and personalized therapy for surfactant deficiency or dysfunction
Surfactant is a pivotal neonatal drug used both for respiratory distress syndrome due to surfactant deficiency and for more complex surfactant dysfunctions (such as in case of neonatal acute respiratory distress syndrome). Despite its importance, indications for surfactant therapy are often based on oversimplified criteria. Lung biology and modern monitoring provide several diagnostic tools to assess the patient surfactant status and they can be used for a personalized surfactant therapy. This is desirable to improve the efficacy of surfactant treatment and reduce associated costs and side effects. (Source: Seminars in Fet...
Source: Seminars in Fetal and Neonatal Medicine - November 22, 2023 Category: Perinatology & Neonatology Authors: Daniele De Luca, Barbara Loi, David Tingay, Humberto Fiori, Paul Kingma, Raffaele Dellac à, Chiara Autilio Source Type: research

Surfactant as a Drug Carrier
Drug delivery using a surfactant vehicle has the potential to prevent systemic side effects by delivering therapeutic agents directly to the respiratory system. The inherent chemical properties of surfactant allows it to readily distribute throughout the respiratory system. Therapeutic agents delivered by surfactant can primarily confer additional benefits but have potential to improve the surfactant function. It is critically important that additional agents do not interefere with the innate surface tension lowering function of surfactant. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 22, 2023 Category: Perinatology & Neonatology Authors: Arun Sett, Charles C. Roehr, Brett J. Manley Source Type: research

Introduction to Surfactant Use in Newborn Infants
Since its introduction in the 1990s, surfactant therapy has been one of the most successful innovations in neonatal intensive care. It has been the mainstay of treatment for respiratory distress syndrome (RDS) and as such has saved the lives of millions of preterm infants over the last three decades. Despite the fact that surfactant therapy has been undisputed for several decades, surfactant treatment strategies have also evolved over time. This evolution was sparked by important changes in respiratory management, especially the increasing use of non-invasive respiratory support modalities. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 22, 2023 Category: Perinatology & Neonatology Authors: Anton H. van Kaam Source Type: research

Synthetic Surfactants
David Sweet was the local PI on the CHF5633 first in human trial as well as the follow up study which was sponsored by Chiesi ® pharmaceuticals and has received speakers fees from them in the past. No other financial interests to declare. Jan Johansson has no current COI to declare. Fernando Moya received an honorarium from Chiesi for participation on an "RDS Expert Panel". (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 22, 2023 Category: Perinatology & Neonatology Authors: Fernando Moya, Tore Curstedt, Jan Johansson, David Sweet Source Type: research

Historical Perspective on Surfactant Therapy: Transforming Hyaline Membrane Disease to Respiratory Distress Syndrome
Lung surfactant is the first drug so far designed for the special needs of the newborn. In 1929, Von Neergard described lung hysteresis and proposed the role of surface forces. In 1955 –1956, Pattle and Clements found direct evidence of lung surfactant. In 1959, Avery discovered that the airway’s lining material was not surface-active in hyaline membrane disease (HMD). Patrick Bouvier Kennedy’s death, among half-million other HMD-victims in 1963, stimulated surfactant resear ch. The first large surfactant treatment trial failed in 1967, but by 1973, prediction of respiratory distress syndrome using surfactant biomark...
Source: Seminars in Fetal and Neonatal Medicine - November 21, 2023 Category: Perinatology & Neonatology Authors: Mikko Hallman, Egbert Herting Source Type: research

Timing of surfactant treatment in respiratory distress syndrome
The introduction of exogenous surfactant in the 1980s has resulted in an improved survival of very preterm infants with respiratory distress syndrome. Randomized controlled trials conducted before 2000 have shown the magnitude of this beneficial effect strongly depends on the timing of surfactant treatment, i.e. the earlier surfactant is administered after birth the better. However, the initial mode of respiratory support in infants with respiratory distress syndrome (RDS) has changed dramatically over the last decades, moving from invasive to non-invasive support. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 21, 2023 Category: Perinatology & Neonatology Authors: Anton H. van Kaam, Hendrik J. Niemarkt, Wes Onland Source Type: research

Alternative Routes of Surfactant Application – an Update
Non-invasive modes of respiratory support have been shown to be the preferable way of primary respiratory support of preterm infants with respiratory distress syndrome (RDS). The avoidance of invasive mechanical ventilation can be beneficial for preterm infants in reduction of morbidity and even mortality. However, it is well-established that some infants managed with non-invasive respiratory support from the outset have symptomatic RDS to a degree that warrants surfactant administration. Infants for whom non-invasive respiratory support ultimately fails are prone to adverse outcomes, occurring at a frequency on par with t...
Source: Seminars in Fetal and Neonatal Medicine - November 21, 2023 Category: Perinatology & Neonatology Authors: Angela Kribs, Kari D. Roberts, Daniele Trevisanuto, Colm O-Donnell, Peter A. Dargaville Source Type: research

Surfactant delivery by aerosol inhalation – past, present, and future
Surfactant replacement therapy (SRT) by nebulization to spontaneously breathing patients has been regarded as the Holy Grail since surfactant deficiency was first identified as the cause for neonatal respiratory distress syndrome. It avoids neonatal endotracheal intubation, a procedure that is often difficult and occasionally harmful. Unapproved alternatives to endotracheal tube placement for liquid surfactant instillation, such as LISA (thin catheter intubation) and SALSA (supraglottic airway insertion) have significant merit but are still invasive, leaving nebulized SRT as the only truly non-invasive method. (Source: Sem...
Source: Seminars in Fetal and Neonatal Medicine - November 21, 2023 Category: Perinatology & Neonatology Authors: Scott O. Guthrie, J. Jane Pillow, James J. Cummings Source Type: research

Towards personalized therapies for genetic disorders of surfactant dysfunction
Genetic disorders of surfactant dysfunction are a rare cause of chronic, progressive or refractory respiratory failure in term and preterm infants. This review explores genetic mechanisms underpinning surfactant dysfunction, highlighting specific surfactant-associated genes including SFTPB, SFTPC, ABCA3, and NKX2.1. Pathogenic variants in these genes contribute to a range of clinical presentations and courses, from neonatal hypoxemic respiratory failure to childhood interstitial lung disease and even adult-onset pulmonary fibrosis. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 21, 2023 Category: Perinatology & Neonatology Authors: Maureen Peers de Nieuwburgh, Jennifer A. Wambach, Matthias Griese, Olivier Danhaive Source Type: research

Neonatal surfactant therapy beyond respiratory distress syndrome
Whilst exogenous surfactant therapy is central to the management of newborn infants with respiratory distress syndrome, its use in other neonatal lung diseases remains inconsistent and controversial. Here we discuss the evidence and experience in relation to surfactant therapy in newborns with other lung conditions in which surfactant may be deficient or dysfunctional, including meconium aspiration syndrome, pneumonia, congenital diaphragmatic hernia and pulmonary haemorrhage. We find that, for all of these diseases, administration of exogenous surfactant as bolus therapy is frequently associated with transient improvement...
Source: Seminars in Fetal and Neonatal Medicine - November 21, 2023 Category: Perinatology & Neonatology Authors: Peter A. Dargaville, Egbert Herting, Roger F. Soll Source Type: research

Perinatal management of the anticipated difficult airway
The ex-utero intrapartum treatment (EXIT) procedure was originally developed to reverse tracheal occlusion in fetuses with severe congenital diaphragmatic hernia that underwent fetal tracheal occlusion. The EXIT procedure has since been applied to a wide range of indications, but the primary indication remains securing a patent airway and providing respiratory support in fetuses with anticipated difficult airways. The authors review perinatal management of the anticipated difficult airway and their single-institution's experience with the EXIT procedure. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 17, 2023 Category: Perinatology & Neonatology Authors: M. Silena Mosquera, Sara Yuter, Alan W. Flake Source Type: research

Success rates and adverse events during neonatal intubation: Lessons learned from an international registry
Neonatal endotracheal intubation is a challenging procedure with suboptimal success and adverse event rates. Systematically tracking intubation outcomes is imperative to understand both universal and site-specific barriers to intubation success and safety. The National Emergency Airway Registry for Neonates (NEAR4NEOS) is an international registry designed to improve neonatal intubation practice and outcomes that includes over 17,000 intubations across 23 international sites as of 2023. Methods to improve intubation safety and success include appropriately matching the intubation provider and situation and increasing adopt...
Source: Seminars in Fetal and Neonatal Medicine - November 17, 2023 Category: Perinatology & Neonatology Authors: Heidi M. Herrick, Mackenzie A. O ’Reilly, Elizabeth E. Foglia Source Type: research

Optimal Timing of Extubation in Preterm Infants
In neonatal intensive care, endotracheal intubation is usually performed as an urgent or semi-urgent procedure in infants with critical or unstable conditions related to progressive respiratory failure. Extubation is not. Patients undergoing extubation are typically stable, with improved respiratory function. The key elements to facilitating extubation are to recognize improvement in respiratory status, promote weaning of mechanical ventilation, and accurately identify readiness for removal of the endotracheal tube. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 17, 2023 Category: Perinatology & Neonatology Authors: Wissam Shalish, Guilherme M. Sant ’Anna Source Type: research

The History of Neonatal Intubation
Interest in ‘resurrecting’ the lifeless by supporting breathing has been described since ancient times. For centuries, methods of resuscitating animals, then humans and specifically the ‘lifeless’ neonate were debated and discussed. Over time, with experimentation and worldwide collaboration, endotrache al tubes and laryngoscopes specific to the newborn were created and their use refined. This historical work has meant that today, the neonatal community focuses on refining the science and the art of intubation for the benefit of the newborn; who, where, when and how to intubate, with what devices a nd medications, ...
Source: Seminars in Fetal and Neonatal Medicine - November 17, 2023 Category: Perinatology & Neonatology Authors: Lucy E. Geraghty, Eoin Ó. Curraín, Lisa K. McCarthy, Colm P.F. O’Donnell Source Type: research

The Neonatal Airway
Safe and effective management of the neonatal airway requires knowledge, teamwork, preparation and experience. At baseline, the neonatal airway can present significant challenges to experienced neonatologists and paediatric anaesthesiologists, and increased difficulty can be due to anatomical abnormalities, physiological instability or increased situational stress. Neonatal airway obstruction is under recognised, and should be considered an emergency until the diagnosis and physiological implications are understood. (Source: Seminars in Fetal and Neonatal Medicine)
Source: Seminars in Fetal and Neonatal Medicine - November 17, 2023 Category: Perinatology & Neonatology Authors: Toby Kane, David G. Tingay, Anastasia Pellicano, Stefano Sabato Source Type: research