摘要：After the first successful trial of surfactant replacement therapy for preterm infants with respiratory distress syndrome (RDS) by Fujiwara in 1980, several animal-derived natural surfactants and synthetic surfactants have been developed. Synthetic surfactants were made to overcome limitations of natural surfactants such as expensiveness, immune reactions, and infections due to animal proteins contained in natural surfactants. However, first-generation synthetic surfactants that are protein-free have failed to prove superiority over natural surfactants because they do not have surfactant protein (SP). Lucinactant, a second-generation synthetic surfactant containing analog of SP-B, was better or at least as effective as natural surfactant, suggesting that lucinactant could be used as an alternative to natural surfactants. Lucinactant was approved by US FDA in March 2012 as a fifth surfactant to treat neonatal RDS. CHF5633, a second-generation synthetic surfactant containing analogues of both SP-B and SP-C, was effective and safe in human multicenter cohort study for preterm infants. Many comparative studies of natural surfactants used worldwide have reported different efficacies according to preparations. However, these differences are believed to due to site variations, not real differences. The more important thing than the preparation of surfactant to improve the outcome is the timing and the mode of administration of surfactant. A new synthetic surfactant containing synthetic phospholipid incorporated with analogues of SP-B and SP-C will be a potential alternative to natural surfactants in the coming years and treatment modality such as less-invasive method or non-invasive method of surfactant administration will be the most important task to be solved.
