Request Copyright Permission

Aerosolized Surfactants for the Treatment of Neonatal Respiratory Distress Syndrome: Challenges and Opportunities

DiBlasi RM, KenKnight H.

Respiratory Drug Delivery 2024. Volume 1, 2024: 9-20.

Abstract:

The mortality and morbidity associated with respiratory distress syndrome (RDS) in premature infants remains high worldwide necessitating innovative strategies to improve outcomes. The standard administration of exogenous surfactant replacement therapy (SRT) as an intratracheal liquid bolus has drawbacks due to its invasive nature. In response to this challenge, aerosol surfactant therapy (AST) has been proposed. Aerosols can be administered without mechanical ventilation and interfaced with other noninvasive respiratory support modalities. Current investigational delivery systems for AST have shown some improved outcomes, mainly for larger premature infants. However, for smaller infants < 28 weeks, AST still demonstrates higher failure rates. This may be due to the delivery devices previously used to administer AST not meeting the requirements of the specific anatomical and physiologic characteristics of smaller preterm infants with RDS, together with high extrapulmonary medication losses, leaving very little aerosol to penetrate the distal airspaces. This paper reviews challenges associated with AST and explores new opportunities for treating infants suffering from RDS.