Exogenous Surfactant in the Neonate Suggestions for its use in developing countries

n spite of improvement in perinatal assistance, the frequency of Respiratory Distress Syndrome in preterm babies (NRDS) remains very high. The estimated incidence of NRDS in babies with a birth weight of 500750 g (very low birth weight -VLBW-) reaches a value of over 80% and in babies with a birth weight between 1000 and 1500 g the frequency is over the 30% (1). Survival significantly improved with the introduction of new techniques of prevention and of treatment of the disease, in particular, after the introduction of the exogenous surfactant. In the United States of America (USA), the neonatal mortality related to NRDS declined by 28% between 1988 and 1991; this data was temporally associated with widespread use of surfactant therapy and was the single most important factor for the reduction in overall neonatal mortality in the US. (1) Now, the exogenous surfactant is in widespread use in many countries, however, there is great variability in its use, within and among countries, related not only to different medical strategies and organisations, but also to the costs. The surfactant preparations currently on the market are relatively expensive and their supply is relatively limited. Therefore an accurate planning of the indications is necessary. Prevention of NRDS Two main strategies are available for the prevention of NRDS (prophylaxis): -one is antenatal (before-birth) with the administration of corticosteroids to mothers, at risk of preterm delivery, thus accelerating fetal lung maturation and -one is after birth, by giving in the delivery room, as soon as possible, exogenous surfactant to the new-borns.