The introduction of exogenous surfactant in the 1980s has resulted in an improved survival of very preterm infants with respiratory distress syndrome (RDS). Randomized controlled trials conducted before 2000 have shown that the magnitude of this beneficial effect strongly depends on the timing of surfactant treatment, i.e. the earlier surfactant is administered after birth the better. However, the initial mode of respiratory support in infants with RDS has changed dramatically over the last decades, moving from invasive to non-invasive support. Furthermore, new, less invasive techniques to administer surfactant have been introduced to match this non-invasive approach. This review summarizes the evidence on how these practice changes impacted the effect of surfactant timing on mortality and morbidity in preterm infants with RDS.

20 世纪 80 年代外源性表面活性剂的引入提高了患有呼吸窘迫综合征 (RDS) 的早产儿的生存率。2000年之前进行的随机对照试验表明，这种有益效果的大小很大程度上取决于表面活性剂治疗的时间，即出生后越早施用表面活性剂越好。然而，RDS 婴儿最初的呼吸支持模式在过去几十年中发生了巨大变化，从侵入性支持转向非侵入性支持。此外，还引入了新的、侵入性较小的表面活性剂施用技术来匹配这种非侵入性方法。本综述总结了这些实践变化如何影响表面活性剂用药时机对 RDS 早产儿死亡率和发病率影响的证据。