Clinical trials and pilot studies on exogenous surfactant supplementation

• Neonates with lung injury not related to prematurity

  • Congenital diaphragmatic hernia
    • After surgical repair

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After surgical repair, the unexpanded lung maintains the tendency to collapse. Manual recruitment can be difficult and lead to a risk of barotrauma due to agensia of the lung or to inhomogeneous re-expansion of long time collapsed and compressed lung. In these conditions surfactant deficiency can be suspected. Re-ventilating the collapsed lung, in presence of controlateral normoexpanding lung, the ventilation is deviated toward better compliant lung, overexpanding it and not affecting less compliant lung. In these conditions, disconnection of the infant from ventilation is difficult due to tendency to collapse of less compliant lung.

Independent lung ventilation and selective surfactant application have been described in a pilot study by Marraro et coll. on 4 post-operative treatment patients affected by long duration atelectasis. Rapid improvement of gas exchange, lung mechanics and chest x-ray were demonstrated as a result of better aeration of the damaged lung and reduced over-expansion of the controlateral lung. Final extubation was possible after a mean of 5 days and no infant was oxygen-dependent after extubation.

Marraro G, Galassini EM, Padovani EM. Biol. Neonate 1998