Intra-amniotic surfactant for women at risk of preterm birth for preventing respiratory distress in newborns

There is no current evidence from randomised controlled trials to guide the use of intra-amniotic instillation of surfactant for women at risk of preterm birth.

Respiratory distress syndrome caused by a deficiency of natural lung detergent (surfactant) occurs mainly in infants born before term (37 weeks' gestation). The usual treatment includes instilling artificial surfactant directly into the newborn infant's airway followed by mechanical ventilation. However, this process can lead to lung injury, which can affect the infant's long-term health. A potential alternative strategy is to inject surfactant into the amniotic fluid around the fetus close to the infant's mouth and nostrils before birth. Preliminary animal and human study suggests that surfactant enters the fetal lungs through fetal breathing efforts. This has the potential to reduce the need to support the infant's breathing after birth, as well as lung damage caused by mechanical ventilation. This review found no randomised controlled trials of intra-amniotic instillation of surfactant for women at risk of preterm birth. In view of the encouraging results from animal studies and preliminary human study, high-quality studies of intra-amniotic instillation of surfactant for women at risk of preterm birth are needed.