The evolution of surfactant replacement therapy: From pathophysiology to noninvasive clinical strategies
1 University School of Medical Laboratory Sciences, Rayat Bahra Professional University, Hoshiarpur, Punjab, India.
2 Department of Allied Health Sciences, Golden Institute of Management and Technology, Gurdaspur, Punjab, India.
3 Department of Public health, medical sciences, University of Hyderabad, Hyderabad, Telangana, India.
Review
International Journal of Biological and Pharmaceutical Sciences Archive, 2026, 11(01), 105-111.
Article DOI: 10.53771/ijbpsa.2026.11.1.0021
Publication history:
Received on 13 January 2026; revised on 21 February 2026; accepted on 23 February 2026
Abstract:
Background: Respiratory Distress Syndrome (RDS) continues to be a major factor in neonatal health issues and fatalities, particularly in preterm babies. While Surfactant Replacement Therapy (SRT) has been the accepted treatment since the 1990s, advancements in respiratory support, like the transition to noninvasive ventilation, demand a fresh look at the types of surfactants and their delivery methods.
Objective: This review investigates the pathophysiology of RDS, the biochemical structure of pulmonary surfactants, and how effective various treatment strategies are, including a comparison between natural and synthetic solutions along with invasive and noninvasive techniques.
Methods: This research combines information from randomized clinical trials and meta-analyses that examine surfactant storage pools, the functions of surfactant proteins (SP-A, B, C, and D), and the timing of interventions (preventive versus rescue).
Results: Currently, natural surfactants that come from animals are favored because they contain important hydrophobic proteins (SP-B and C), although newer synthetic options such as Lucinactant are promising in minimizing batch variability and the risk of immune reactions. There is strong clinical evidence that supports administering "early rescue therapy" within 1 to 2 hours of birth instead of waiting for treatment. In addition, techniques like Less Invasive Surfactant Administration (LISA) and INSURE have greatly lowered the need for mechanical ventilation and have reduced the occurrence of bronchopulmonary dysplasia (BPD).
Conclusion: SRT serves as a fundamental component of neonatal intensive care, greatly decreasing mortality rates and the occurrence of pulmonary air leaks. Current practices in neonatology are shifting from routine intubation to a more selective approach that includes rescue therapy along with noninvasive support. Upcoming developments are focused on enhancing synthetic peptide analogues and nebulized delivery methods to further reduce lung damage.
Keywords:
Respiratory Distress Syndrome (RDs); Surfactant Replacement Therapy (SRT); Preterm Infants; DPPC (Dipalmitoylphosphatidylcholine); Surfactant Proteins (Sp-B, Sp-C); Less Invasive Surfactant Administration (Lisa)
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