Surfactant status assessment and personalized therapy for surfactant deficiency or dysfunction.

Surfactant is a pivotal neonatal drug used both for respiratory distress syndrome due to surfactant deficiency and for more complex surfactant dysfunctions (such as in case of neonatal acute respiratory distress syndrome). Despite its importance, indications for surfactant therapy are often based on oversimplified criteria. Lung biology and modern monitoring provide several diagnostic tools to assess the patient surfactant status and they can be used for a personalized surfactant therapy. This is desirable to improve the efficacy of surfactant treatment and reduce associated costs and side effects. In this review we will discuss these diagnostic tools from a pathophysiological and multi-disciplinary perspective, focusing on the quantitative or qualitative surfactant assays, lung mechanics or aeration measurements, and gas exchange metrics. Their biological and technical characteristics are described with practical information for clinicians. Finally, available evidence-based data are reviewed, and the diagnostic accuracy of the different tools is compared. Lung ultrasound seems the most suitable tool for assessing the surfactant status, while some other promising tests require further research and/or development.

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Déclaration de conflit d'intérêts

Declaration of competing interest Prof.De Luca received speaker fees or research grant/assistance or has served as consultant for Chiesi Farmaceutici, Airway Therapeutics, Getinge, Vyaire (formerly Sensormedics, Carefusion and Acutronic), Medtronic, Masimo, Radiometer, Philips and General Electrics, not related to this manuscript. He has stock option from Ophirex ltd which produces phospholipase inhibitors and is unrelated to the topic of this manuscript. Prof. Kingma was previously employed by but currently has no financial relationship with Airway Therapeutics; the relationship ended before the conception of this manuscript. Prof. Tingay is supported by a National Health and Medical Research Council Leadership Level 1 Investigator Fellowship (Grant ID 2008212). Prof. Tingay received speaker fees by SLE Ltd UK and Vyaire not related to this manuscript. Prof. Dellacà received speaker fees or travels grant from Vyaire and Chiesi Farmaceutici not related to this manuscript; his institution, received research grants and license fees for patents from Chiesi Farmaceutici, Vyaire, Philips and Restech for research topics not related to this manuscript. None of these companies had any role in the conception or writing of this article for any of the authors.