Surfactant status assessment and personalized therapy for surfactant deficiency or dysfunction

Daniele De Luca; Barbara Loi; David Tingay; Humberto Fiori; Paul Kingma; Raffaele Dellacà; Chiara Autilio

doi:10.1016/j.siny.2023.101494

Surfactant status assessment and personalized therapy for surfactant deficiency or dysfunction

Semin Fetal Neonatal Med. 2023 Dec;28(6):101494. doi: 10.1016/j.siny.2023.101494. Epub 2023 Nov 23.

Authors

Daniele De Luca¹, Barbara Loi², David Tingay³, Humberto Fiori⁴, Paul Kingma⁵, Raffaele Dellacà⁶, Chiara Autilio⁷

Affiliations

¹ Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit, INSERM U999, Paris Saclay University, Paris, France; Department of Pediatrics, Division of Neonatology, Stanford University, School of Medicine - Lucile Packard Children's Hospital, Palo Alto, CA, USA. Electronic address: [email protected].
² Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit, INSERM U999, Paris Saclay University, Paris, France.
³ Neonatal Research Unit, Murdoch Children's Research Institute, Parkville, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia.
⁴ Division of Neonatology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
⁵ Perinatal Institute, Cincinnati Children's University Hospital Medical Center, Cincinnati, OH, USA.
⁶ Department of Electronics, Information and Bio-engineering, Polytechnical University of Milan, Milan, Italy.
⁷ Department of Biochemistry and Molecular Biology and Research Institute Hospital October 12 (imas12), Faculty of Biology, Complutense University, Madrid, Spain; Clinical Pathology and Microbiology Unit, San Carlo Hospital, Potenza, Italy.

PMID: 38016825
DOI: 10.1016/j.siny.2023.101494

Abstract

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. In this review we will discuss these diagnostic tools from a pathophysiological and multi-disciplinary perspective, focusing on the quantitative or qualitative surfactant assays, lung mechanics or aeration measurements, and gas exchange metrics. Their biological and technical characteristics are described with practical information for clinicians. Finally, available evidence-based data are reviewed, and the diagnostic accuracy of the different tools is compared. Lung ultrasound seems the most suitable tool for assessing the surfactant status, while some other promising tests require further research and/or development.

Keywords: Lung; Oxygenation; Prematurity; Respiratory distress syndrome; Ultrasound.

Publication types

Review

MeSH terms

Humans
Infant, Newborn
Lipoproteins / therapeutic use
Lung
Pulmonary Surfactants* / therapeutic use
Respiratory Distress Syndrome, Newborn* / diagnosis
Respiratory Distress Syndrome, Newborn* / drug therapy
Surface-Active Agents / therapeutic use

Substances

Surface-Active Agents
Pulmonary Surfactants
Lipoproteins