Leading expert in neonatal respiratory distress syndrome, Dr. Tore Curstedt, MD, co-invented the life-saving medication Curosurf, an exogenous surfactant that treats premature babies who cannot produce their own. Dr. Tore Curstedt, MD, explains how this medication dramatically improves oxygen uptake within minutes of administration by decreasing alveolar surface tension, preventing lung collapse, and facilitating expansion during inspiration. Before its development, even babies born at 34 weeks, like President Kennedy's son, frequently died from this condition despite the best available care.
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Understanding Neonatal Respiratory Distress Syndrome and Surfactant Treatment
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- What is Neonatal Respiratory Distress Syndrome?
- How Surfactant Treatment Works
- Curosurf Treatment Protocol and Dosage
- Immediate Effects of Surfactant Therapy
- Historical Context and Development
- Impact on Premature Baby Survival
What is Neonatal Respiratory Distress Syndrome?
Neonatal respiratory distress syndrome (RDS) is a life-threatening condition primarily affecting premature infants whose lungs are underdeveloped. The core problem is a critical deficiency of a substance called pulmonary surfactant. Dr. Tore Curstedt, MD, explains that without this surfactant, the tiny air sacs in the lungs, known as alveoli, cannot function properly. This leads to an inability to breathe effectively and a dangerous lack of oxygen in the bloodstream and tissues.
How Surfactant Treatment Works
Exogenous surfactant medication, like Curosurf, works by replicating the function of natural surfactant. Dr. Curstedt details that the treatment performs two essential roles. First, it dramatically diminishes the surface tension within the alveoli. Second, it lines the alveoli to facilitate their expansion. This dual action makes it significantly easier for the lungs to open up during inspiration, allowing for vital oxygen intake. Furthermore, it prevents the alveoli from collapsing completely during expiration, which is the hallmark of RDS.
Curosurf Treatment Protocol and Dosage
The treatment protocol for surfactant replacement is remarkably efficient. Dr. Tore Curstedt, MD, states that the medication typically only needs to be administered once, twice, or a maximum of three times. This is due to the material's half-life of approximately one to two days. The key window for treatment is the first two to four days of life. During this critical period, about 40% of babies require only a single dose, while the remaining 40-60% may need two or three doses to bridge the gap until their own lungs begin producing sufficient endogenous surfactant.
Immediate Effects of Surfactant Therapy
The clinical effects of surfactant administration are both rapid and visually dramatic. Dr. Curstedt describes how a premature baby suffering from severe oxygen deprivation, often appearing blue (cyanotic), can transform into a pink, well-oxygenated baby within just two to four minutes. This immediate improvement occurs because the surfactant enables the lungs to finally uptake oxygen from the air and transfer it into the blood, providing the oxygen necessary for metabolism and survival.
Historical Context and Development
The link between a lack of surfactant and respiratory distress syndrome in premature babies was established in the late 1950s by Dr. Mary Ellen Avery. Despite this knowledge, a effective treatment remained elusive for decades. Dr. Tore Curstedt, MD, highlights a poignant historical example: the son of President John F. Kennedy, born at 34 weeks gestation weighing 2.1 kilograms, died of RDS in 1963 despite receiving care at one of the best hospitals in Boston. This tragedy underscored the urgent, unmet medical need that Dr. Curstedt and his colleague, Dr. Bengt Robertson, began working to address through their pioneering surfactant research.
Impact on Premature Baby Survival
The invention of Curosurf and similar exogenous surfactants fundamentally changed neonatal outcomes. Before its availability, RDS was a leading cause of death in premature infants, as they simply could not uptake oxygen. Dr. Curstedt's work provided a simple yet profoundly effective solution that directly addresses the root cause of the syndrome. The medication's ability to support breathing for the critical first few days of life gives premature infants the time they need to mature and start producing their own surfactant, thereby saving millions of lives worldwide.
Full Transcript
Dr. Anton Titov, MD: Dr. Curstedt, you invented a medication called Curosurf that helps to save lives—millions of babies around the world now. Would you please briefly describe what is the problem that your medication so successfully treats?
Dr. Tore Curstedt, MD: Premature babies don't have a component called surfactant. If they don't have surfactant, they cannot breathe because this surfactant lines the alveoli. The alveoli don't collapse during expiration, and the medication makes it easier for alveoli to expand during inspiration. If the babies can survive two or three days, they will start to produce their own surfactant.
Dr. Anton Titov, MD: The key is these first several days of life?
Dr. Tore Curstedt, MD: The key is the first two, three, or four days of life. Usually you have to give this exogenous surfactant once, twice, or perhaps three times—not more than that. The half-life time for this material is one to two days.
Dr. Anton Titov, MD: The medication that you co-invented only needs to be given once, twice, or three times to a prematurely born baby. That makes all the difference in saving the baby's life.
Dr. Tore Curstedt, MD: Yes. Perhaps 40% of the babies need the medication only once. Perhaps the other 40 to 60% need the medication two or three times.
Dr. Anton Titov, MD: How does the medication work?
Dr. Tore Curstedt, MD: The medication will diminish the surface tension in the lungs and it will line the alveoli. It will increase the possibility for the alveoli to open up. The surfactant will decrease the surface tension in the alveoli and it will line the alveoli. During inspiration, it makes it much easier to open up lungs. It will also prevent the alveoli from collapsing during expiration.
Dr. Anton Titov, MD: When you give this medication to the baby, to a prematurely born baby, then it prevents the collapse of the alveoli and that is the hallmark of the respiratory distress syndrome.
Dr. Tore Curstedt, MD: Yes, also to prevent the collapse. But also to make it easier to open up so you can have oxygen into the lungs and oxygen taken up by the blood.
Dr. Anton Titov, MD: It is a very seemingly simple action. But nevertheless it is such a dramatic effect. Before Curosurf, the medication you invented, became available, babies died because the oxygen just couldn't get to their tissues.
Dr. Tore Curstedt, MD: Yeah, because they couldn't take up oxygen. In that case, you have this premature baby. These are blue babies—they can't take up the oxygen and they can't use the oxygen. They have no oxygen to use for their metabolism. If you give the surfactant, you can see in a couple of minutes that the blue baby will be a pink baby.
Dr. Anton Titov, MD: It is a very easily observed and fast effect.
Dr. Tore Curstedt, MD: It is very fast, in a couple of minutes—two, three, or four minutes.
Dr. Anton Titov, MD: You invented the medication that can be given just once, twice, or three times to a prematurely born baby and it changes the life.
Dr. Tore Curstedt, MD: It changes the life and it will get them to survive. Of course, it was already known before that you have the surface active material called surfactant. Dr. Mary Avery had shown in the late 1950s that premature babies had a lack of endogenous surfactant.
Dr. Anton Titov, MD: You have the connection with surface active material—lack of surface active material in premature babies. But this was known in the late 1950s. But you can also see that in 1963, President Kennedy and his wife got a premature child. He was born in week 34.
Dr. Anton Titov, MD: It was not that premature...
Dr. Tore Curstedt, MD: No, it is not—it is a little premature.
Dr. Anton Titov, MD: Six weeks before term.
Dr. Tore Curstedt, MD: Six weeks... the weight was 2.1 kilogram, so a big baby. He died of respiratory distress syndrome. Even if they knew about surfactant, it was impossible to give the babies exogenous surfactant at that time, and that was 1963.
Dr. Anton Titov, MD: They were treated at one of the best US hospitals in Boston.
Dr. Tore Curstedt, MD: Yes, it was. It was the president's child, of course.
Dr. Anton Titov, MD: The best hospital.
Dr. Tore Curstedt, MD: The best hospital. The best treatment at that time.
Dr. Anton Titov, MD: Somewhere, thousands of miles away, a young researcher, Dr. Tore Curstedt, started to work on how to fix that problem.
Dr. Tore Curstedt, MD: Yes, I and my colleague, Dr. Bengt Robertson, we had started. Of course it was also in other places of the world—they also started with surfactant research.