Pulmonary drug delivery by surfactant
Journal
Pediatrics and Neonatology
Journal Volume
56
Journal Issue
1
Pages
3-4
Date Issued
2015
Author(s)
Abstract
Exogenous surfactant and early use of nasal continuous positive airway pressure significantly decreased the incidence and severity of respiratory distress syndrome (RDS) and improved the survival of preterm infants. However, the incidence of RDS-related complication-chronic lung disease (CLD) is still high.1Nakhshab M. Tajbakhsh M. Khani S. Farhadi R. Comparison of the effect of surfactant administration during nasal continuous positive airway pressure with that of nasal continuous positive airway pressure alone on complications of respiratory distress syndrome: a randomized controlled study.Pediatr Neonatol. 2015; 56: 19-24Abstract Full Text Full Text PDF Google Scholar, 2Dunn M.S. Kaempf J. de Klerk A. de Klerk R. Reilly M. Howard D. et al.Randomized trial comparing three approaches to the initial respiratory management of preterm neonates.Pediatrics. 2011; 128: e1069-e1076Crossref PubMed Scopus (338) Google Scholar This may be due to the multifactorial etiology of CLD. Recently, Huang et al3Huang L.T. Yeh T.F. Kuo Y.L. Chen P.C. Chen C.M. Effect of surfactant and budesonide on the pulmonary distribution of fluorescent dye in mice.Pediatr Neonatol. 2014; (pii:S1875–9572(14)00128–4, [Epub ahead of print])https://doi.org/10.1016/j.pedneo.2014.04.009Abstract Full Text Full Text PDF Scopus (22) Google Scholar reported that combined administration of surfactant and budesonide further increased the fluorescent intensity in the lungs of mice compared with the control condition. This study may give us an alternative therapeutic strategy for not only treating RDS but also for preventing the subsequent development of CLD in preterm infants.The causes of bronchopulmonary dysplasia (BPD) include immaturity, genetic susceptibility, prolonged oxygen therapy, barotrauma, inflammation, and nutritional deficiency.4Martin R.J. Fanaroff A.A. The preterm lung and airway: past, present, and future.Pediatr Neonatol. 2013; 54: 228-234Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar Among these factors, inflammation induced by oxygen therapy or sepsis plays an important role in the pathogenesis of CLD in preterm infants, especially for those with RDS. Therefore, systemic glucocorticoids have been used to prevent or treat CLD in preterm infants who required prolonged mechanical ventilation by suppressing the lung inflammation. However, because of the systemic adverse effects on neurodevelopmental outcome, systemic glucocorticoids are not recommended for routine use now.5Yeh T.F. Lin Y.J. Lin H.C. Huang C.C. Hsieh W.S. Lin C.H. et al.Outcome at school age after postnatal dexamethasone therapy for lung disease of prematurity.N Engl J Med. 2004; 350: 1304-1313Crossref PubMed Scopus (467) Google Scholar So far, no effective therapy has been proven useful in preventing CLD in preterm infants.Because preterm infants complicated with RDS require oxygen therapy or ventilator support right after birth, the CLD-related inflammatory process may also start as early as the first breath. Thus, intratracheal delivery steroid with surfactant for preterm infants with RDS may have the advantages of early prevention of inflammation and of decreasing the side effects of the steroid due to local treatment rather than systemic therapy. Previously Yeh et al6Yeh T.F. Lin H.C. Chang C.H. Wu T.S. Su B.H. Li T.C. et al.Early intratracheal instillation of budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants: a pilot study.Pediatrics. 2008; 121: e1310-e1318Crossref PubMed Scopus (130) Google Scholar demonstrated that early postnatal intratracheal instillation of budesonide using surfactant as a vehicle significantly improved the combined outcome of death or chronic lung disease, and also increased the number of survivors without CLD. However, the pulmonary distribution of budesonide is not clear. By using the in vivo image system, Huang et al3Huang L.T. Yeh T.F. Kuo Y.L. Chen P.C. Chen C.M. Effect of surfactant and budesonide on the pulmonary distribution of fluorescent dye in mice.Pediatr Neonatol. 2014; (pii:S1875–9572(14)00128–4, [Epub ahead of print])https://doi.org/10.1016/j.pedneo.2014.04.009Abstract Full Text Full Text PDF Scopus (22) Google Scholar demonstrated that mice treated with both surfactant and budesonide showed a significant increase in fluorescent intensity compared with mice treated with either surfactant or budesonide alone. These data show that surfactant is not only powerful for treating RDS, but also that surfactant alone or with budesonide can be used as an effective vehicle for pulmonary drug delivery.Conflicts of interestThe author declares no conflicts of interest. Exogenous surfactant and early use of nasal continuous positive airway pressure significantly decreased the incidence and severity of respiratory distress syndrome (RDS) and improved the survival of preterm infants. However, the incidence of RDS-related complication-chronic lung disease (CLD) is still high.1Nakhshab M. Tajbakhsh M. Khani S. Farhadi R. Comparison of the effect of surfactant administration during nasal continuous positive airway pressure with that of nasal continuous positive airway pressure alone on complications of respiratory distress syndrome: a randomized controlled study.Pediatr Neonatol. 2015; 56: 19-24Abstract Full Text Full Text PDF Google Scholar, 2Dunn M.S. Kaempf J. de Klerk A. de Klerk R. Reilly M. Howard D. et al.Randomized trial comparing three approaches to the initial respiratory management of preterm neonates.Pediatrics. 2011; 128: e1069-e1076Crossref PubMed Scopus (338) Google Scholar This may be due to the multifactorial etiology of CLD. Recently, Huang et al3Huang L.T. Yeh T.F. Kuo Y.L. Chen P.C. Chen C.M. Effect of surfactant and budesonide on the pulmonary distribution of fluorescent dye in mice.Pediatr Neonatol. 2014; (pii:S1875–9572(14)00128–4, [Epub ahead of print])https://doi.org/10.1016/j.pedneo.2014.04.009Abstract Full Text Full Text PDF Scopus (22) Google Scholar reported that combined administration of surfactant and budesonide further increased the fluorescent intensity in the lungs of mice compared with the control condition. This study may give us an alternative therapeutic strategy for not only treating RDS but also for preventing the subsequent development of CLD in preterm infants. The causes of bronchopulmonary dysplasia (BPD) include immaturity, genetic susceptibility, prolonged oxygen therapy, barotrauma, inflammation, and nutritional deficiency.4Martin R.J. Fanaroff A.A. The preterm lung and airway: past, present, and future.Pediatr Neonatol. 2013; 54: 228-234Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar Among these factors, inflammation induced by oxygen therapy or sepsis plays an important role in the pathogenesis of CLD in preterm infants, especially for those with RDS. Therefore, systemic glucocorticoids have been used to prevent or treat CLD in preterm infants who required prolonged mechanical ventilation by suppressing the lung inflammation. However, because of the systemic adverse effects on neurodevelopmental outcome, systemic glucocorticoids are not recommended for routine use now.5Yeh T.F. Lin Y.J. Lin H.C. Huang C.C. Hsieh W.S. Lin C.H. et al.Outcome at school age after postnatal dexamethasone therapy for lung disease of prematurity.N Engl J Med. 2004; 350: 1304-1313Crossref PubMed Scopus (467) Google Scholar So far, no effective therapy has been proven useful in preventing CLD in preterm infants. Because preterm infants complicated with RDS require oxygen therapy or ventilator support right after birth, the CLD-related inflammatory process may also start as early as the first breath. Thus, intratracheal delivery steroid with surfactant for preterm infants with RDS may have the advantages of early prevention of inflammation and of decreasing the side effects of the steroid due to local treatment rather than systemic therapy. Previously Yeh et al6Yeh T.F. Lin H.C. Chang C.H. Wu T.S. Su B.H. Li T.C. et al.Early intratracheal instillation of budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants: a pilot study.Pediatrics. 2008; 121: e1310-e1318Crossref PubMed Scopus (130) Google Scholar demonstrated that early postnatal intratracheal instillation of budesonide using surfactant as a vehicle significantly improved the combined outcome of death or chronic lung disease, and also increased the number of survivors without CLD. However, the pulmonary distribution of budesonide is not clear. By using the in vivo image system, Huang et al3Huang L.T. Yeh T.F. Kuo Y.L. Chen P.C. Chen C.M. Effect of surfactant and budesonide on the pulmonary distribution of fluorescent dye in mice.Pediatr Neonatol. 2014; (pii:S1875–9572(14)00128–4, [Epub ahead of print])https://doi.org/10.1016/j.pedneo.2014.04.009Abstract Full Text Full Text PDF Scopus (22) Google Scholar demonstrated that mice treated with both surfactant and budesonide showed a significant increase in fluorescent intensity compared with mice treated with either surfactant or budesonide alone. These data show that surfactant is not only powerful for treating RDS, but also that surfactant alone or with budesonide can be used as an effective vehicle for pulmonary drug delivery. Conflicts of interestThe author declares no conflicts of interest. The author declares no conflicts of interest.
SDGs
Publisher
Elsevier (Singapore) Pte Ltd
Type
editorial