Surfactant in the preterm infant: what's going on.

Surfactant treatment has been demonstrated to decrease pneumothorax and mortality in preterm infants. Natural surfactants are better than synthetic surfactants. Early rescue treatment with surfactant is better than late treatment, whereas the role of surfactant prophylaxis is under re-evaluation due to the actual large diffusion of antenatal steroid and nasal continuous positive airway pressure treatment which have changed the clinical characteristics of preterm infants with respiratory distress syndrome. It is possible that in the next future anti-inflammatory and anti-oxidant properties of exogenous natural surfactants may be improved through their combination with adequate agents with the aim of counteracting the pathogenetic role of inflammatory and oxidative lung injury injuries in the development of brochopulmonary dysplasia.