Research Shows Surfactant Treatment Offers No Additional Benefit for Critically Ill Infants with Severe Bronchiolitis

A significant UK-led clinical trial has demonstrated that surfactant therapy, commonly used to aid premature infants' breathing, does not improve outcomes for babies critically ill with severe bronchiolitis—a viral respiratory illness that results in high hospitalization rates among infants annually.

The findings were announced at the 34th International Congress of the European Society for Pediatric and Neonatal Intensive Care (ESPNIC) held in Alicante, Spain.

Bronchiolitis is typically caused by the respiratory syncytial virus (RSV) and affects the lungs of young children, especially those under one year old. It leads to inflammation and obstruction of the small airways, making breathing difficult. Unlike premature infants, who often lack sufficient lung surfactant, full-term babies can produce enough; however, in severe cases like bronchiolitis, the reduced surfactant might contribute to respiratory distress.

To assess whether surfactant therapy could help in these severe cases, researchers conducted the BESS trial—the largest randomized study of its kind—spanning 15 hospitals in England, Scotland, and Northern Ireland. The trial involved 232 critically ill infants requiring mechanical ventilation. The results indicated that surfactant did not shorten the duration of ventilation or improve clinical recovery.

Professor Calum Semple, the study’s lead researcher from the University of Liverpool and Alder Hey Children's NHS Foundation Trust, explained, "While surfactant treatment was safe, it did not influence how long these babies needed ventilatory support. Our goal was to find an effective treatment, but the current evidence suggests it should not be used routinely in severe bronchiolitis cases."

Bronchiolitis remains the leading cause of hospital admissions during winter in the UK, primarily affecting infants under one year old. Although most recover with supportive care such as oxygen and fluids, around a thousand require intensive care and ventilatory support each year. Presently, there are no approved specific treatments beyond supportive therapies.

The study emphasizes the importance of preventive measures, including the ongoing promotion of RSV vaccination during pregnancy, which can offer protection to newborns. The researchers also highlight that surfactant therapy continues to be crucial for premature infants and advocate for further research into targeted treatments for bronchiolitis.

This research underscores the need for continued investigation into effective interventions for severe bronchiolitis, aiming to reduce the burden on healthcare systems and improve outcomes for the most vulnerable infants.

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