History of Pulmonary Surfactant Replacement Therapy for Neonatal Respiratory Distress Syndrome in Korea

Abstract

Neonatal respiratory distress syndrome (RDS) is a disease that is unique to newborn infants. It is caused by a deficiency of pulmonary surfactant (PS), which is usually ready to be activated around the perinatal period. Until RDS was more clearly understood, it was not known why premature infants died from respiratory failure, although pathology revealed hyaline membranes in the alveoli. Surprisingly, the era of PS replacement therapy began only relatively recently. The first clinical trial investigating neonatal RDS was conducted in 1980. Since then, newborn survival has improved dramatically, which has led to significant advances in the field of neonatology. The present comprehensive review addresses PS, from its discovery to the application of artificial PS in newborns with RDS. It also reviews the history of PS in Korea, including its introduction, various commercial products, present and past research, newborn registries, and health insurance issues. Finally, it describes the inception of the Korean Society of Neonatology and future directions of research and treatment.

Keywords: History of Medicine; Infant, Premature; Korea; Pulmonary Surfactants; Respiratory Distress Syndrome, Newborn.

Fig. 1. Changes of neonatal SRs for VLBWI and ELBWI in Korea (1960–2014.6). Data adapted from Shim et al.

SR = survival rate, ELBWI = extremely low birth weight infants, VLBWI = very low birth weight infants. ^aP < 0.05 vs. late 1960s; ^bP < 0.001 vs. late 1960s; ^cP < 0.05 vs. late 1960s; ^dP < 0.001 vs. late 1960s.

Fig. 2. Comparison of the neonatal SRs of VLBWI and ELBWI between Korea, Japan, US, Canada, Europe, Australia and New Zealand, and Taiwan. Data adapted from Chung et al.

SR = survival rate, VLBWI = very low birth weight infants, ELBWI = extremely low birth weight infants, KNN = Korean Neonatal Network, NRNJ = Neonatal Research Network of Japan, VON = Vermont Oxford Network; CNN = Canadian Neonatal Network, ANZNN = Australian and New Zealand Neonatal Network, EuroNeoNet = European Neonatal Network, TPIFN = Taiwan Premature Infant Follow-up Network.