Surfactant Deficiency in Newborns

Surfactant deficiency in premature infants is a serious, possibly life-threatening  condition that results in respiratory distress and pulmonary failure if left untreated. Pulmonary surfactant is a naturally occurring slippery substance made of phospholipids and proteins; it lines the alveoli, or air sacs, in the lungs and reduces surface tension. This serves to help the lungs function properly and prevents alveoli collapse. Infants suffering from surfactant deficiency do not have enough open alveoli to draw in sufficient air.

Newborns without enough pulmonary surfactants are diagnosed with respiratory distress syndrome (RDS). The symptoms may include: rapid,shallow breathing; flared nostrils showing physical strain in breathing; sharp pulling in of the chest below and between the ribs; wheezing and grunting as the body tries to retain air; and bluish or pale grey coloring of the skin due to lack of oxygen. Infants with surfactant deficiency may also experience apnea, which is the occasional stoppage of breath.

Premature infants are most prone to RDS; more than half of those born before 28 weeks of pregnancy are diagnosed with the condition. This is because pulmonary surfactants began to be produced around 24 to 36 weeks of gestation. Infants born prematurely have not developed adequate levels of surfactant and therefore need assistance in breathing for the first few days.

Treatment options for surfactant deficiency may include all or several of the following

Artificial surfactant therapy: directly administering surfactant to the infant's lungs. Usually one dose is enough, but some infants require repeated treatment over the course of two to three days.

Mechanical ventilator: assists the infant in breathing by pushing air into the lungs through a breathing tube.

Nasal continuous positive airway pressure (NCPAP): assists in breathing by continuously pushing air into the lungs through small tubes inserted into the nose.

Extra oxygen: infants with respiratory distress require a higher level of oxygen. Room air is combined with pure oxygen and is delivered via a ventilator or NCPAP.

Treatment depends on various factors including: the infant's gestational age; his or her overall health; the severity of the respiratory distress; the doctor's expectations for prognosis; and the infant's tolerance of treatment. If the clinician expects a premature birth to be likely, he or she may also prescribe corticosteroid injections for the mother to speed up surfactant production and lung development. Usually, the infant should start making enough pulmonary surfactant within 24 hours.