[Exogenous surfactant therapy in pediatrics].
OBJECTIVE
To review current knowledge about the use of exogenous surfactants in the treatment of different lung diseases causing acute respiratory failure in children.


METHODS
This review is based on the author's experience and on recent data retrieved from ONIA, Mdconsult, Medline and the Cochrane Database Library.


RESULTS
In spite of the success of the use of exogenous surfactants in Respiratory Distress Syndrome (RDS) of the newborn, some questions remain unanswered, such as the optimal administration timing - either very early (prophylactic), based on gestational age or on quick tests of lung maturity, or later, when the clinical picture becomes unequivocal. In other severe diseases requiring ventilatory support, the use of surfactants is still controversial, and data in the literature are limited and conflicting. However, successful use in several other diseases has been reported. Recent studies have focused on surfactant inactivation by substances that can be found in the airways. New surfactants with the addition of substances to control inhibition, such as polyethyleneglycol, are being tested for diseases in which inactivation seems to be a significant factor.


CONCLUSIONS
Therapy with exogenous surfactants, even as a treatment for RDS, has not been thoroughly investigated. Further studies should be conducted to improve surfactants - mainly their resistance to inhibition - and the treatment of diseases other than RDS.
Freddi
Norberto A
NA
Hospital Santa Catarina, São Paulo, SP, Brazil. nafreddi@uol.com.br
Filho
José Oliva Proença
JO
Fiori
Humberto H
HH
D000208:Acute Disease; D002648:Child; D006801:Humans; D007231:Infant, Newborn; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy*; D012131:Respiratory Insufficiency / Q000188:drug therapy*
D011663:Pulmonary Surfactants