Yenidoğanda Surfaktan Tedavisi
Synopsis
Respiratory distress syndrome (RDS) is a major cause of morbidity and mortality developing due to pulmonary immaturity and alveolar surfactant deficiency in premature infants, with an incidence that increases as gestational age decreases. Pulmonary surfactant is a vital biochemical mixture consisting of 90% lipids and 10% proteins that reduces surface tension by preventing alveolar collapse during the respiratory cycle. While dipalmitoylphosphatidylcholine (DPPC) is the primary molecule reducing surface tension, hydrophilic (SP-A, SP-D) and hydrophobic (SP-B, SP-C) surfactant proteins play critical roles in innate immune defense and biophysical spreading functions. Exogenous surfactant therapy is currently the standard treatment for RDS, and natural preparations derived from bovine or porcine sources (poractant alfa, beractant, calfactant) are preferred in clinical practice. Studies demonstrate that particularly high-dose poractant alfa administration can yield superior outcomes in reducing mortality, ventilation requirements, and the risk of bronchopulmonary dysplasia (BPD). In terms of timing, early rescue therapy administered within the first two hours stands out, whereas administration techniques have evolved from conventional endotracheal intubation toward less invasive methods such as INSURE, LISA, and MIST. Surfactant applications combined with antenatal steroid use and non-invasive respiratory support improve lung compliance and minimize ventilator injury. Additionally, surfactant therapy is successfully utilized in other clinical conditions leading to secondary surfactant deficiency, such as meconium aspiration syndrome, pulmonary hemorrhage, and neonatal pneumonia.
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