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Surfactant replacement therapy

Surfactant recently has become available in Australia for the treatment of respiratory distress syndrome (RDS) in babies. Surfactant replacement has been introduced here after randomized controlled trials overseas have shown it to reduce mortality markedly. Not only is it the first therapy to be developed specifically for neonates but because of its effectiveness in reducing mortality, it is one of the most effective forms of treatment ever studied by randomized controlled trial. This review discusses surfactant, the results of its use in clinical trials and addresses some of the questions that still remain unanswered: (1) Is surfactant best administered in high risk neonates before the onset of respiratory distress (‘prophylactic’ mode) or only to those who have established disease (‘rescue’ mode)? (2) Is one type of surfactant better than another? (3) What is the optimal dose of surfactant? How often does it