Taking their first breath of air was a big challenge for premature babies until a London, Ontario scientist's discovery changed all that and saved thousands of newborns.

[ News Release 2009-30 ]

Until the 1980s, Respiratory Distress Syndrome (RDS) often claimed the lives of babies born even just a few weeks premature. Their tiny lungs could not inflate properly, and research had not found a solution to the problem. Some believed that premature babies couldn't produce enough of a natural material called pulmonary surfactant, which is needed to reduce the surface tension of water within the lung and enables the lung's surface area to expand.

Some investigators had tried blowing a surfactant-like lipid mixture into the premature lungs, but these tests were unsuccessful and were discontinued.

Dr. Fred Possmayer, professor emeritus at the University of Western Ontario's Schulich School of Medicine, was astonished by how many premature babies died of RDS in the neonatal intensive care ward at St. Joseph's Hospital in London, Ontario.

In collaboration with Dr. Goran Enhorning in Toronto, Possmayer demonstrated in tests with a fetal rabbit model that surfactant could help premature bunnies breathe easier and survive.

"We conducted studies where we actually showed that you could keep them alive. There was absolutely no doubt that this stuff worked," said Possmayer. "But the problem was you can't take surfactant out of a cow, or a pig, or a rabbit and put in a premature baby."

Now Possmayer faced the challenge of extracting, purifying, and sterilizing the surfactant without destroying its protective effect. Previous attempts to sterilize the surfactant by a number of methods, including x-rays, ended up inactivating the surfactant proteins. Instead, he established methods using organic solvent extraction, which many had believed would completely destroy the surfactant's activity. Instead, the surfactant remained effective, while all microorganisms and nonsurfactant protein contaminants were eliminated.

Then, the group began testing the safe surfactant, named Bovine Lipid Extract Surfactant (BLES), in premature babies at Saint Joseph's Hospital and at the Hospital for Sick Children and Women's College Hospital in Toronto. Testing showed that, to be successful the surfactant needed be given early and that the ventilator needed to be fine tuned or the infant's lungs would become irreparably damaged.

With the new protocol premature babies were given surfactant immediately after it was noticed there was an indication of RDS. The results were amazing. Within minutes, the baby's circulation improved and oxygen levels could be lowered in the ventilator.

Now, thanks to the surfactant and other new medical interventions for premature babies, the risk of dying due to RDS is much lower.

After saving the lives of countless babies, Possmayer's work on surfactant has shifted from children to adults. Thousands of people suffer acute lung injury every year due to pneumonia, near drowning, or even car accidents. In many cases, the lung's biodefense system responds by secreting cytokines that activate white blood cells to seek out and kill any invading viruses or bacteria. Unfortunately, those same cells can get carried away, attacking the lungs and other organs leading to multiple organ failure and death.

But, surfactant can play a crucial role in preventing this destructive cell activation and could be a way to stop multiple organ failure. "If you could use surfactant early enough, you would stop that cytokine cascade, and if you could do that you could short circuit the system," said Possmayer.

And, so Possmayer continues to work on fully understanding how surfactant does what it does. "You need to understand something to take advantage of it otherwise it's really hit or miss. If you understand something a bit you can only use it a bit, but if understand something better then you can really use it."