How does surfactant really work?
Although administration of exogenous surfactant to the neonate with RDS often relieves hypoxia rapidly, it is events occurring some 18-48 h later that determine the ultimate clinical outcome, indicating a vital second stage to 'rescue'. It is proposed that, whereas a reduction in surface tension facilitates the initial penetration of the lungs by air, the second stage is provided by surface-active phospholipid (SAPL) slowly adsorbing (binding) to alveolar epithelium to displace water in the same way that surfactants are widely used industrially as 'de-watering' agents. In the normal newborn, this de-watering lining of SAPL is already in place, explaining the extremely rapid expulsion of fluid from the lungs at birth. The selection or formulation of a surfactant for rescue should thus take both stages into consideration.
Hills
B A
BA
Paediatric Respiratory Research Centre, Mater Children's Hospital, South Brisbane, Queensland, Australia.
D000328:Adult; D015633:Extravascular Lung Water / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn / Q000502:physiology*; D007234:Infant, Premature; D008168:Lung / Q000187:drug effects / Q000502:physiology*; D008954:Models, Biological; D011650:Pulmonary Alveoli / Q000502:physiology; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D011663:Pulmonary Surfactants / Q000494:pharmacology / Q000502:physiology* / Q000627:therapeutic use; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy / Q000503:physiopathology
D011663:Pulmonary Surfactants