Surfactant and neonatal hemodynamics during the postnatal transition

Semin Fetal Neonatal Med. 2023 Dec;28(6):101498. doi: 10.1016/j.siny.2023.101498. Epub 2023 Nov 23.


Surfactant replacement therapy (SRT) has revolutionized the management of respiratory distress syndrome (RDS) in premature infants, leading to improved survival rates and decreased morbidity. SRT may, however, be associated with hemodynamic changes, which can have both positive and negative effects on the immature cardiovascular system, during the transitional adaptation from fetal to extrauterine environment. However, there is a relative paucity of evidence in this domain, with most of them derived from small heterogeneous observational studies providing conflicting results. In this review, we will discuss the hemodynamic changes that occur with surfactant administration during this vulnerable period, focusing on available evidence regarding changes in pulmonary and systemic blood flow, cerebral circulation and their clinical implications.

Keywords: Cardiac output; Hemodynamics; Preterm; Surfactant; Transitional circulation.

Publication types

  • Review

MeSH terms

  • Hemodynamics / physiology
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Observational Studies as Topic
  • Pulmonary Surfactants* / therapeutic use
  • Respiratory Distress Syndrome, Newborn*
  • Surface-Active Agents / therapeutic use


  • Pulmonary Surfactants
  • Surface-Active Agents