@misc{sardesai_s._evolution_2017,
	title = {Evolution of surfactant therapy for respiratory distress syndrome: {Past}, present, and future},
	url = {http://www.nature.com/pr/index.html},
	abstract = {Respiratory distress syndrome (RDS) due to surfactant deficiency is the most common cause of respiratory failure in preterm infants. Tremendous progress has been made since the original description that surfactant deficiency is the major cause of RDS. Surfactant therapy has been extensively studied in preterm infants and has been shown to significantly decrease air leaks and neonatal and infant mortality. Synthetic and animal-derived surfactants from bovine as well as porcine origin have been evaluated in randomized controlled trials. Animal-derived surfactants generally result in faster weaning of respiratory support, shorter duration of invasive ventilation, and decreased mortality when compared to first- or second-generation of synthetic surfactants, but some of the second-generation synthetic surfactants are at least not inferior to the animal-derived surfactants. Using a higher initial dose of porcine derived surfactant may provide better outcomes when compared with using lower doses of bovine surfactants, likely, due to compositional difference and/or the dose. Third-generation synthetic surfactant containing peptide analogs of surfactant protein B and C are currently being studied. Less invasive intra-tracheal surfactant administration techniques in spontaneously breathing neonate receiving noninvasive ventilator support are also being evaluated. In the present era, prophylactic surfactant is not recommended as it may increase the risk of lung injury or death. In the future, surfactants may be used as vector to deliver steroids, or used in combination with molecules, such as, recombinant Club Cell Protein-10 (rhCC-10) to improve pulmonary outcomes. Also, noninvasive surfactant administration techniques, such as aerosolization or atomization of surfactant may play a greater role in the future. Copyright © 2017 International Pediatric Research Foundation, Inc.},
	journal = {Pediatric Research},
	author = {{Sardesai S.} and {Biniwale M.} and {Wertheimer F.} and {Garingo A.} and {Ramanathan R.}},
	year = {2017},
	keywords = {*respiratory distress syndrome, *respiratory distress syndrome/dt [Drug Therapy], *surfactant, *surfactant/ct [Clinical Trial], *surfactant/dt [Drug Therapy], *surfactant/dv [Drug Development], Clara cell, assisted ventilation, bovine, bovine derived surfactant/cm [Drug Comparison], bovine derived surfactant/ct [Clinical Trial], bovine derived surfactant/dt [Drug Therapy], bovine derived surfactant/dv [Drug Development], budesonide/dt [Drug Therapy], cell protein, death, drug therapy, endogenous compound, human, infant mortality, lung injury, nebulization, newborn, nonhuman, noninvasive ventilation, outcome assessment, peptide, pig, porcine derived surfactant/cm [Drug Comparison], porcine derived surfactant/ct [Clinical Trial], porcine derived surfactant/dt [Drug Therapy], porcine derived surfactant/dv [Drug Development], prematurity, priority journal, randomized controlled trial (topic), recombinant club cell protein 10/dt [Drug Therapy], recombinant protein/dt [Drug Therapy], respiratory distress syndrome/dt [Drug Therapy], respiratory failure, review, steroid, surfactant protein B, surfactant protein B/dt [Drug Therapy], surfactant protein C/dt [Drug Therapy], synthetic surfactant/cm [Drug Comparison], synthetic surfactant/ct [Clinical Trial], synthetic surfactant/dt [Drug Therapy], synthetic surfactant/dv [Drug Development], time to treatment, trachea, unclassified drug, ventilator weaning}
}

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Surfactant therapy has been extensively studied in preterm infants and has been shown to significantly decrease air leaks and neonatal and infant mortality. Synthetic and animal-derived surfactants from bovine as well as porcine origin have been evaluated in randomized controlled trials. Animal-derived surfactants generally result in faster weaning of respiratory support, shorter duration of invasive ventilation, and decreased mortality when compared to first- or second-generation of synthetic surfactants, but some of the second-generation synthetic surfactants are at least not inferior to the animal-derived surfactants. Using a higher initial dose of porcine derived surfactant may provide better outcomes when compared with using lower doses of bovine surfactants, likely, due to compositional difference and/or the dose. Third-generation synthetic surfactant containing peptide analogs of surfactant protein B and C are currently being studied. Less invasive intra-tracheal surfactant administration techniques in spontaneously breathing neonate receiving noninvasive ventilator support are also being evaluated. In the present era, prophylactic surfactant is not recommended as it may increase the risk of lung injury or death. In the future, surfactants may be used as vector to deliver steroids, or used in combination with molecules, such as, recombinant Club Cell Protein-10 (rhCC-10) to improve pulmonary outcomes. Also, noninvasive surfactant administration techniques, such as aerosolization or atomization of surfactant may play a greater role in the future. 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Tremendous progress has been made since the original description that surfactant deficiency is the major cause of RDS. Surfactant therapy has been extensively studied in preterm infants and has been shown to significantly decrease air leaks and neonatal and infant mortality. Synthetic and animal-derived surfactants from bovine as well as porcine origin have been evaluated in randomized controlled trials. Animal-derived surfactants generally result in faster weaning of respiratory support, shorter duration of invasive ventilation, and decreased mortality when compared to first- or second-generation of synthetic surfactants, but some of the second-generation synthetic surfactants are at least not inferior to the animal-derived surfactants. Using a higher initial dose of porcine derived surfactant may provide better outcomes when compared with using lower doses of bovine surfactants, likely, due to compositional difference and/or the dose. Third-generation synthetic surfactant containing peptide analogs of surfactant protein B and C are currently being studied. Less invasive intra-tracheal surfactant administration techniques in spontaneously breathing neonate receiving noninvasive ventilator support are also being evaluated. In the present era, prophylactic surfactant is not recommended as it may increase the risk of lung injury or death. In the future, surfactants may be used as vector to deliver steroids, or used in combination with molecules, such as, recombinant Club Cell Protein-10 (rhCC-10) to improve pulmonary outcomes. Also, noninvasive surfactant administration techniques, such as aerosolization or atomization of surfactant may play a greater role in the future. 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