Comparative Analysis of early surfactant administration versus Standard Care in neonatal sepsis

Paula Ramirez; V. Torres; M. Castro

doi:10.5281/zenodo.22814803

Authors

Paula Ramirez Division of Neonatology, Krishna Research Center for Neonatology Author https://orcid.org/9334-4335-6850-0713
V. Torres Department of Clinical Neonatology, Ebro Research Center for Pediatric Research Author https://orcid.org/8258-3671-4146-6757
M. Castro Department of Pediatric Research, Amur Center for Pediatric Research Author https://orcid.org/2170-2283-1613-3246

DOI:

https://doi.org/10.5281/zenodo.22814803

Keywords:

neonatal sepsis, pulmonary surfactant, respiratory distress, surfactant inactivation, mechanical ventilation

Abstract

Graphical abstract

Background: Neonatal sepsis frequently produces a secondary surfactant dysfunction syndrome that resembles primary respiratory distress syndrome, because inflammatory mediators and proteinaceous exudate inactivate pulmonary surfactant regardless of gestational maturity.

Objective: This review synthesizes evidence comparing early exogenous surfactant administration with standard supportive care alone in neonates with sepsis-associated respiratory failure.

Methods: We synthesized randomized trials, multicenter cohorts, and Cochrane reviews addressing surfactant timing, delivery technique, and respiratory outcomes in septic and infection-associated neonatal respiratory failure.

Findings: Early surfactant reduces oxygenation index and need for extracorporeal support in term and near-term infants with sepsis-related respiratory failure, with the greatest benefit when given before severe decompensation; less invasive delivery extends this advantage to spontaneously breathing preterm infants, though surfactant inactivation by serum proteins blunts the response compared with primary respiratory distress syndrome.

Conclusions: Early, protocol-driven surfactant administration alongside antimicrobial therapy and lung-protective ventilation offers measurable benefit over standard care alone in neonatal sepsis, but optimal timing and patient selection remain incompletely defined.

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