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Background: Exogenous surfactant is currently administered via intra-tracheal instillation, a method which can increase the possibility of clinical instability in the peri-surfactant administration period. Since its introduction, there has been an increase in understanding of the pathology of respiratory distress syndrome and surfactant biology. This includes development of a potential nebulized surfactant which has the potential to increase the number, safety and timely administration of the medication in preterm infants. Data sources: Based on recent original publications in the field of surfactant biology, we reviewed our experience with surfactant administration and discussed the available evidence on nebulized surfactant and outlined potential barriers toward widespread introduction of this therapy. Results: Surfactant has revolutionized modern neonatal management and nebulized surfactant is attractive and a vector for administration. However, issues regarding costeffectiveness, development of nebulizer devices capable of administration, deposition of medication in the airway and dosing strategies remain unresolved. Conclusions: Nebulized surfactant has the potential to be a therapeutic breakthrough by eliminating the potent volu-and-baro-traumatic effects of mechanical ventilation in the peri-surfactant period. Nebulization would likely lead to increased administration immediately after birth and more emphasis on noninvasive ventilator strategies. These features will aid clinical implementation of nebulized surfactant as a standard of treatment after introduction. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the association between the mode of delivery and the risk of neonatal respiratory complications in a cohort of term newborns in the Lazio region, Italy. Data on 139,379 term singleton infants born in 2003-2005 were retrieved from birth and hospital discharge database. Odds Ratios (ORs) adjusted by age, parity, birth weight, gestational age, and gender were calculated using logistic regression models. The rate of prelabor cesarean section (CS) was 26.2%. The rates of neonatal respiratory morbidity were 29.6/1,000 in infants delivered by prelabor CS and 17.4/1,000 in infants delivered vaginally or by CS in labor. The adjusted risk of neonatal respiratory morbidity associated with prelabor cesarean birth at 37 weeks is four times higher than in intended vaginal birth after 37 weeks. Prelabor cesarean delivery should be performed after at least 38 weeks' of gestation in order to minimize neonatal respiratory morbidity. [ABSTRACT FROM AUTHOR]

Research studies have highlighted both physiological and pathological evidence to incriminate surfactant abnormality and/or deficiency in many neonatal respiratory diseases. Data from animal models and clinical studies support the concept that surfactant replacement therapy (SRT) may have a role to play in such problems. There is now, therefore, a need to perform further randomized controlled trials to assess the appropriate clinical application of SRT in non-respiratory distress syndrome neonatal respiratory disease. [ABSTRACT FROM AUTHOR]