What Is Surfactant Deficiency? What Are the Treatment Methods?

What Is Surfactant Deficiency? What Are the Treatment Methods?

Surfactant deficiency lies at the root of several respiratory diseases that occur in newborns. Particularly in premature babies, a deficiency of surfactant-containing fluid within the first few hours after birth presents with certain signs. These babies require one-on-one monitoring and immediate intensive care support. The disease caused by the absence of surfactant in the respiratory system of premature babies is called “Respiratory Distress Syndrome.” It is also known by another name, “Hyaline Membrane Disease.” In premature births attended by experienced pediatricians, early diagnosis can be made by monitoring the signs in the baby during the first few minutes or hours. For this reason, clinics that have a neonatologist and a neonatal unit are highly effective both in early diagnosis and in the correct treatment of premature birth. Acute respiratory distress syndrome can be resolved with correct monitoring and treatment by a neonatal intensive care team that is expert in its field.

Why Does Surfactant Deficiency Occur in Newborn Babies?

Surfactant is a substance that begins to be secreted from the embryonic period onward, once the baby’s development is complete, so that the respiratory system can perform its functions without problems. Surfactant begins to be synthesized as early as the 20th week of pregnancy. Although it begins to be produced at the 20th week of pregnancy, its transfer between the alveoli, the start of full functionality, and its storage reach the 24th week. This substance is a lipoprotein produced by the body to minimize surface tension between the alveoli. It is composed of 90% lipid (fat) and 10% protein.

Alveoli, small sacs inside the lungs, form the fundamental building block of the respiratory system. Alveoli are small sacs that branch out within the lung. Because they are arranged in a structure like clusters of grapes, adjacent to one another, they inflate and deflate with every breath. This enables the movement of the lung. However, during this process, the contact between alveoli causes a kind of friction. This situation creates surface tension in the lung. This naturally occurring process has a negative effect on breathing and prevents the alveoli from inflating. Surfactant, on the other hand, minimizes surface tension with its slippery structure, allowing the alveoli to fill with air and ensuring that breathing takes place healthily.

During embryonic development, the lungs are not organs that perform respiration. The baby breathes through gas exchange via the umbilical cord. The baby’s first breath occurs at the moment the lungs become active and begin to inflate at birth. During the embryonic period, the lungs are filled with fluid. During this developmental process, surfactant is the first substance to begin being synthesized in the respiratory system. By the 35th week, sufficient surfactant begins to be secreted, enabling the baby to breathe normally at birth. Surfactant is synthesized by alveolar type 2 cells located in the space between the alveoli. At birth, the baby’s first breath is expected to occur normally thanks to surfactant.

As the time spent in the womb decreases, the rate of neonatal diseases in babies increases. Diseases and breathing difficulties caused by insufficient synthesis of surfactant are also proportional to the baby spending an insufficient amount of time in the womb. However, many other causes can explain surfactant deficiency in premature babies. The most common causes of the respiratory problem caused by surfactant deficiency are:

The mother’s history of multiple pregnancies

Maternal history of diabetes

Late or early cutting of the umbilical cord

Cesarean delivery

Multiple births

History of respiratory distress in previous pregnancies

Absence of a detectable pulse in the baby (asphyxia)

Low birth weight (cases under 1250 grams are common)

Sepsis

Meconium aspiration in the baby

Mutation in the gene that provides surfactant synthesis

Although a history of premature birth is the most fundamental cause of surfactant deficiency, conditions arising during delivery and pregnancy can also lead to surfactant deficiency. In addition, respiratory distress caused by surfactant deficiency is seen more frequently in premature male babies.

The respiratory system disease caused by surfactant deficiency at birth is called acute respiratory distress syndrome. It is an acutely developing disease because its signs appear within a few hours after birth in a newborn and it must be recognized and treated urgently by a specialist physician. It can also be described as a disease caused by surfactant deficiency, abbreviated as ARDS. For diseases such as ARDS, where diagnosis and treatment are a race against time in premature babies, the presence of an experienced physician monitoring the condition is very important. Especially in cases of early birth, the presence of a child health and diseases specialist or a surgeon who will also attend the delivery is a factor that demonstrates the competence of clinics. This is because acute diseases such as ARDS can be easily recognized by a specialist right away, and the baby can be treated with correct treatment without a lasting health problem.

In Which Treatment Methods Is Surfactant Used?

Surfactant deficiency can be noticed from the first few hours after birth up to the first 2 days. Since this problem is generally more common in newborn cases, newborn babies should normally be under intensive care observation. In the services provided by clinics that offer sufficient equipment and physician support, including a neonatal intensive care unit, the baby under follow-up is monitored every minute. By closely monitoring the critical process in the baby, respiratory distress syndrome that may develop due to surfactant deficiency can be noticed early. In babies under observation, this disease may give an alarm by presenting with one or more of the following findings:

Tachypnea after birth (rapid, frequent and inadequate breathing)

Cyanosis (bluish discoloration)

Dry cough

Movement while trying to breathe

Hypoxemia (insufficient oxygen in the blood)

Ground-glass appearance on chest X-ray

These symptoms may appear in the first minutes after birth. Generally, the findings are fully observed within the first 4 hours. If the symptoms last longer than 24 hours, the diagnosis of ARDS is confirmed by the history obtained from the mother and father, the baby’s chest X-ray, and laboratory tests. Starting treatment together with the diagnosis both increases the chance of survival and minimizes the likelihood of permanent damage. Therefore, the conditions of the treating hospital, performing adequate examinations and tests, and confirming the results from a specialist’s perspective are very important.

Surfactant therapy can raise survival rates in premature RDS cases to 90% or above. However, prenatal treatments given to the mother before the baby is born, in cases where the baby is at risk of surfactant deficiency, may also be beneficial. As prophylactic treatment (preventing a disease from occurring when there is a risk of it in the baby), steroids can be given to the mother. If there is a risk of premature birth, steroid therapy may be effective.

After birth, respiratory support should be provided to the baby in the neonatal intensive care unit. With CPAP or IPPV respiratory support devices, continuous oxygen support is provided to the baby without any invasive surgical intervention. Oxygen saturation should be kept between 90% and 95%. This greatly reduces morbidity in the baby. The most important step in treatment is the administration of surfactant. According to studies conducted, there is no medical treatment as effective as natural surfactant preparations for ARDS. Surfactant preparations should be available in the setting of every premature birth and should be administered as needed by a specialist physician. In particular, administration should be carried out as soon as possible after delivery. If the baby receiving respiratory support has stable breathing, a second dose may not be administered. However, if the expected values have not yet been achieved, respiratory support should be continued and a repeat dose can be administered after at least 2 hours.

Along with surfactant therapy, the nutrition the newborn needs should be provided. Taking a larger than normal amount of fluid may be recommended. During this period, the baby may receive mother’s milk through a nasogastric or endotracheal tube. In addition, a venous line may be opened for electrolyte support and other medical support treatments. The baby’s incubator temperature is kept at 36.5–37.5 degrees. Respiratory distress is treated with oxygen monitoring, nutrition and fluid support under the supervision of a specialist team.

Frequently Asked Questions

Surfactant deficiency and the resulting respiratory distress problem fall within the group of neonatal (newborn) diseases and, if left untreated, have serious consequences. Delays in diagnosing ARDS and inadequate treatment, above all, lead to a condition that can result in death. In early births, the most important cause of death and respiratory distress is surfactant deficiency. For this reason, the most important reason for treating this condition, which leads to permanent diseases, is to prevent infant death. Although surfactant deficiency is more common in premature babies, it can also be seen in babies born at full term. The frequency of ARDS in babies under 28 weeks is a serious 93%. This rate is quite low in babies born at full term, but it can still occur. Respiratory distress caused by surfactant deficiency is a treatable problem. Surfactant deficiency, the most common cause of death in premature births, and the acute respiratory distress syndrome it causes must be diagnosed at the time of birth, and if there is a risk beforehand, specialist physician monitoring is needed to prevent the disease. Diseases such as ARDS can be overcome by physicians who have gained experience in their field, inspire confidence in the patient, and also involve the patient actively in the treatment process. In addition, clinical services that provide sufficient medication, technical and surgical support gain importance in this treatment. For diseases such as ARDS, which can be diagnosed early and have a fully successful treatment option, you can get counseling and book an appointment with our clinic right away to prevent the disease from developing.