Artificial surfactant therapy for hyaline membrane disease

The demonstration that the lungs of infants who died with hyaline membrane disease (HMD) had abnormal surface properties' prompted a number of attempts to treat the condition by administration of material with surface tension-lowering properties. The substance mainly used for this purpose during the period 1964-7 was synthetic dipalmitoyllecithin (DPL) prepared as an aerosol either in a mixture of propylene glycol and water or in a freon carrier.2 3 The results were uniformly disappointing and treatment with surfactant was soon stopped in favour of nonspecific supportive measures. The efforts exerted by neonatologists for achieving adequate resuscitation at birth, warmth, control of acid base status, and improved methods of assisted ventilation and blood-gas monitoring seem to have led to improved survival of preterm infants with HMD.4 Prenatal administration of steroids to induce maturation of the biochemical pathways for surfactant synthesis has also provided a possible means of preventing HMD in suitable cases.5 The possibility of prevention or treatment of HMD by instillation of artificial surfactant into the airways has however seemed sufficiently attractive to persuade several groups of workers to resume experimental studies in this area, particularly during the last 5 years.6-1" Fujiwara et al.12 have recently reported results after artificial surfactant treatment in a further small series of infants with HMD. In this issue (page 758), Morley et al.13 in a more cautious approach, compare the effects of administration of artificial with those of natural surfactant on the lungs of preterm rabbits. At this stage there are two questions which the neonatologist may reasonably ask. Firstly, has there been a significant increase in knowledge and technical ability during the last decade which justifies further consideration of a previously discredited mode of treatment? Secondly, if treatment with artificial surfactant were to be introduced, what would be the realistic prospects for reduction in neonatal mortality and morbidity?