Why, when, and how to give surfactant

Surfactant treatments together with antenatal corticosteroid treatments are uniformly viewed as the most important pharmacological interventions to improve outcomes of preterm infants. Both therapies are old as antenatal corticosteroids became standard of care and was widely used after 1994. Surfactants were first approved by the Food and Drug Administration (FDA) in 1990 and also became standard of care for treating respiratory distress syndrome (RDS). The clinical applications of these old therapies have evolved to be most critical for pregnancies at risk of very preterm deliveries and for the very premature infants. Pediatric Research is publishing this month a consensus statement to promote uniform approaches for surfactant treatment in the United Kingdom. 1 This is a thoughtful approach to treatment based on large clinical and research experiences world-wide, but especially in Europe. 2 I have some comments that may help the reader better assess these recommendations and how they may evolve in the future.