{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T10:49:44Z","timestamp":1792061384284,"version":"4.4.0"},"reference-count":22,"publisher":"Akademiai Kiado Zrt.","content-domain":{"domain":["www.akjournals.com"],"crossmark-restriction":true},"short-container-title":["PHYSINT"],"published-print":{"date-parts":[[2026,10,15]]},"abstract":"Abstract<\/jats:title>\n \n Background and Aim<\/jats:title>\n Neonatal Respiratory Distress Syndrome (NRDS), often caused by surfactant deficiency, is a major concern in preterm infants. This study aimed to explore the relationship between SP-A and SP-D levels and NRDS severity.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A total of 100 preterm neonates diagnosed with NRDS were enrolled and categorized into mild, moderate, and severe groups. Data on surfactant therapy, including the timing and number of doses, were collected, and the response to therapy was assessed by monitoring ventilatory support and stability of oxygenation (FiO\n 2<\/jats:sub>\n < 0.30 for 12\u2009h).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n SP-A and SP-D levels were significantly lower in the severe group compared to the mild and moderate groups (\n P<\/jats:italic>\n < 0.01). Lower levels of these proteins were associated with higher inflammatory markers (CRP and IL-6), more surfactant doses, longer mechanical ventilation, and extended NICU stays (\n P<\/jats:italic>\n < 0.01). Logistic regression revealed that lower SP-A (OR = 0.86) and SP-D (OR = 0.83) were significant predictors of NRDS severity. ROC curve analysis showed AUC values of 0.85 for SP-A and 0.81 for SP-D, highlighting their potential as biomarkers.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n SP-A and SP-D play a crucial role in NRDS pathogenesis and could serve as biomarkers to assess disease severity and guide treatment.<\/jats:p>\n <\/jats:sec>","DOI":"10.1556\/2060.2026.00885","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T10:19:28Z","timestamp":1792059568000},"update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":0,"title":["The role of type III pulmonary surfactants in\u00a0the\u00a0pathogenesis of neonatal respiratory distress\u00a0syndrome (NRDS)"],"prefix":"10.1556","author":[{"given":"Liping","family":"Gao","sequence":"first","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Naval Medical University, Shanghai,200438, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0430-961X","authenticated-orcid":true,"given":"Sampana","family":"Fatima","sequence":"additional","affiliation":[{"name":"Department of Physiology, Shahida Islam Medical College, Lodhran, Punjab, 59320, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"425","reference":[{"key":"B1","series-title":"StatPearls","article-title":"Neonatal respiratory distress syndrome [Internet]","author":"Pattnaik P","year":"2026","unstructured":"Pattnaik P, Adebisi K, Lee B. Neonatal respiratory distress syndrome [Internet]. StatPearls 2026. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15965895."},{"issue":"5","key":"B2","series-title":"Ann Am Thorac Soc","first-page":"765","article-title":"The role of surfactant in lung disease and host defense against pulmonary infections","volume":"12","author":"Han S","year":"2015 May 1","unstructured":"Han S, Mallampalli RK. The role of surfactant in lung disease and host defense against pulmonary infections. Ann Am Thorac Soc [Internet]. 2015 May 1; 12(5): 765\u201374. Available from: https:\/\/academic.oup.com\/annalsats\/article\/12\/5\/765\/8429348."},{"key":"B3","series-title":"Ann Anat - Anat Anzeiger","first-page":"146","article-title":"Lung surfactant: function and composition in the context of development and respiratory physiology","volume":"208","author":"Bernhard W","year":"2016 Nov","unstructured":"Bernhard W. Lung surfactant: function and composition in the context of development and respiratory physiology. Ann Anat - Anat Anzeiger [Internet]. 2016 Nov; 208: 146\u201350. Available from: https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0940960216301546."},{"key":"B4","series-title":"Front Immunol","first-page":"11","article-title":"SP-A and SP-D: dual functioning immune molecules with antiviral and immunomodulatory properties","author":"Watson A","year":"2021 Jan 19","unstructured":"Watson A, Madsen J, Clark HW. SP-A and SP-D: dual functioning immune molecules with antiviral and immunomodulatory properties. Front Immunol [Internet]. 2021 Jan 19; 11. Available from: https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2020.622598\/full."},{"issue":"4","key":"B5","series-title":"Transl Pediatr [Internet]","first-page":"526","article-title":"A systematic review and meta-analysis of pulmonary surfactant combined with budesonide in the treatment of neonatal respiratory distress syndrome","volume":"11","author":"Yi Z","year":"2022 Apr","unstructured":"Yi Z, Tan Y, Liu Y, Jiang L, Luo L, Wang L, et\u00a0al. A systematic review and meta-analysis of pulmonary surfactant combined with budesonide in the treatment of neonatal respiratory distress syndrome. Transl Pediatr [Internet]. 2022 Apr; 11(4): 526\u201336. Available from: https:\/\/tp.amegroups.com\/article\/view\/92917\/html."},{"key":"B6","series-title":"Front Pharmacol [Internet]","article-title":"The role of pulmonary surfactants in the treatment of acute respiratory distress syndrome in COVID-19","volume":"12","author":"Wang S","year":"2021 Jun 29","unstructured":"Wang S, Li Z, Wang X, Zhang S, Gao P, Shi Z. The role of pulmonary surfactants in the treatment of acute respiratory distress syndrome in COVID-19. Front Pharmacol [Internet]. 2021 Jun 29; 12. Available from: https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2021.698905\/full."},{"key":"B7","series-title":"Encyclopedia of respiratory medicine [Internet]","first-page":"152","article-title":"SURFACTANT | Surfactant Protein D (SP-D)","author":"Crouch EC","year":"2006","unstructured":"Crouch EC. SURFACTANT | Surfactant Protein D (SP-D). In: Encyclopedia of respiratory medicine [Internet]. Elsevier; 2006. pp. 152\u20139. Available from: https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/B012370879600380X."},{"key":"B8","series-title":"Murray and Nadel\u2019s textbook of respiratory medicine [Internet]","first-page":"134","article-title":"Alveolar epithelium and pulmonary surfactant","author":"Mason RJ","year":"2016","unstructured":"Mason RJ, Dobbs LG. Alveolar epithelium and pulmonary surfactant. In: Murray and Nadel\u2019s textbook of respiratory medicine [Internet]. Elsevier; 2016. pp. 134\u201349.e5. Available from: https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/B9781455733835000087."},{"key":"B9","series-title":"Fetal and neonatal physiology [Internet]","first-page":"843","article-title":"Genetics and physiology of surfactant protein deficiencies","author":"Nogee LM","year":"2017","unstructured":"Nogee LM. Genetics and physiology of surfactant protein deficiencies. In: Fetal and neonatal physiology [Internet]. Elsevier; 2017. pp. 843\u2013854.e2. Available from: https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/B9780323352147000858."},{"issue":"1","key":"B10","series-title":"Paediatr Child Health","first-page":"35","article-title":"Guidelines for surfactant replacement therapy in neonates","volume":"26","author":"Ng EH","year":"2021 Feb 1","unstructured":"Ng EH, Shah V. Guidelines for surfactant replacement therapy in neonates. Paediatr Child Health [Internet]. 2021 Feb 1; 26(1): 35\u201341. Available from: https:\/\/academic.oup.com\/pch\/article\/26\/1\/35\/6125698."},{"key":"B11","series-title":"J Inflamm Res","first-page":"6439","article-title":"The association between neonatal respiratory distress syndrome and plasma IgG N-Glycosylation: a case-control study","volume":"18","author":"Wang Y","year":"2025 May","unstructured":"Wang Y, Shen Q, Yan R, Wang M, Xu M, Chen H, et\u00a0al. The association between neonatal respiratory distress syndrome and plasma IgG N-Glycosylation: a case-control study. J Inflamm Res [Internet]. 2025 May; 18:6439\u201351. Available from: https:\/\/www.dovepress.com\/the-association-between-neonatal-respiratory-distress-syndrome-and-pla-peer-reviewed-fulltext-article-JIR."},{"key":"B12","series-title":"Glob Pediatr","article-title":"Factors associated with respiratory distress syndrome in preterm neonates admitted to a tertiary hospital in Kabul city: a retrospective cross-sectional study","volume":"3","author":"Aslamzai M","year":"2023 Mar","unstructured":"Aslamzai M, Froogh BA, Mukhlis AH, Faizi OA, Sajid SA, Hakimi Z. Factors associated with respiratory distress syndrome in preterm neonates admitted to a tertiary hospital in Kabul city: a retrospective cross-sectional study. Glob Pediatr [Internet]. 2023 Mar; 3: 100035. Available from: https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2667009723000015."},{"key":"B13","article-title":"Clinical interventions and outcomes in neonates with early-onset respiratory distress: a prospective observational study","author":"Balasubramanian K","year":"2026","unstructured":"Balasubramanian K, Krishnamurthy C, Deepak Kumar T, Manickam K, Kandasamy V. Clinical interventions and outcomes in neonates with early-onset respiratory distress: a prospective observational study. Cureus [Internet]. 2026 Feb 22; Available from: https:\/\/www.cureus.com\/articles\/437784-clinical-interventions-and-outcomes-in-neonates-with-early-onset-respiratory-distress-a-prospective-observational-study."},{"issue":"8","key":"B14","series-title":"Eur J Pediatr","first-page":"596","article-title":"Surfactant protein A in the course of respiratory distress syndrome","volume":"151","author":"Stevens PA","year":"1992 Aug","unstructured":"Stevens PA, Schadow B, Bartholain S, Segerer H, Obladen M. Surfactant protein A in the course of respiratory distress syndrome. Eur J Pediatr [Internet]. 1992 Aug; 151(8): 596\u2013600. Available from: http:\/\/link.springer.com\/10.1007\/BF01957730."},{"issue":"5","key":"B15","series-title":"Thorax","first-page":"460","article-title":"Increased prevalence of low oligomeric state surfactant protein D with restricted lectin activity in bronchoalveolar lavage fluid from preterm infants","volume":"68","author":"Kotecha S","year":"2013 May","unstructured":"Kotecha S, Davies PL, Clark HW, McGreal EP. Increased prevalence of low oligomeric state surfactant protein D with restricted lectin activity in bronchoalveolar lavage fluid from preterm infants. Thorax [Internet]. 2013 May; 68(5): 460\u20137. Available from: https:\/\/thorax.bmj.com\/lookup\/doi\/10.1136\/thoraxjnl-2012-202729."},{"key":"B16","series-title":"Front Immunol","article-title":"An insight into the diverse roles of surfactant proteins, SP-A and SP-D in innate and adaptive immunity","volume":"3","author":"Nayak A","year":"2012","unstructured":"Nayak A, Dodagatta-Marri E, Tsolaki AG, Kishore U. An insight into the diverse roles of surfactant proteins, SP-A and SP-D in innate and adaptive immunity. Front Immunol [Internet]. 2012; 3. Available from: http:\/\/journal.frontiersin.org\/article\/10.3389\/fimmu.2012.00131\/abstract."},{"issue":"139","key":"B17","series-title":"Mod Pediatr Ukr","first-page":"88","article-title":"Significance of surfactant proteins in respiratory distress syndrome in preterm infants","volume":"3","author":"Mirzayeva \u0130A","year":"2024 Apr 28","unstructured":"Mirzayeva \u0130A, Baylarov RO, Gasimova YA, Orujova PA. Significance of surfactant proteins in respiratory distress syndrome in preterm infants. Mod Pediatr Ukr [Internet]. 2024 Apr 28; 3(139): 88\u201392. Available from: http:\/\/mpu.med-expert.com.ua\/article\/view\/307384."},{"issue":"1","key":"B18","series-title":"BMC Pulm Med","first-page":"204","article-title":"Plasma surfactant protein-D as a diagnostic biomarker for acute respiratory distress syndrome: validation in US and Korean cohorts","volume":"17","author":"Park J","year":"2017 Dec 15","unstructured":"Park J, Pabon M, Choi AMK, Siempos II, Fredenburgh LE, Baron RM, et\u00a0al. Plasma surfactant protein-D as a diagnostic biomarker for acute respiratory distress syndrome: validation in US and Korean cohorts. BMC Pulm Med [Internet]. 2017 Dec 15; 17(1): 204. Available from: https:\/\/bmcpulmmed.biomedcentral.com\/articles\/10.1186\/s12890-017-0532-1."},{"key":"B19","series-title":"Front Med","article-title":"Surfactant protein D in respiratory and non-respiratory diseases","volume":"5","author":"Sorensen GL","year":"2018 Feb 8","unstructured":"Sorensen GL. Surfactant protein D in respiratory and non-respiratory diseases. Front Med [Internet]. 2018 Feb 8; 5. Available from: http:\/\/journal.frontiersin.org\/article\/10.3389\/fmed.2018.00018\/full."},{"issue":"147","key":"B20","series-title":"Mod Pediatr Ukr","first-page":"55","article-title":"Association between plasma surfactant proteins A and D levels and types of respiratory therapy in preterm neonates","volume":"3","author":"Mirzayeva \u0130A","year":"2025 Apr 28","unstructured":"Mirzayeva \u0130A, Baylarov RO, Orujova PA. Association between plasma surfactant proteins A and D levels and types of respiratory therapy in preterm neonates. Mod Pediatr Ukr [Internet]. 2025 Apr 28; 3(147): 55\u20139. Available from: http:\/\/mpu.med-expert.com.ua\/article\/view\/335385."},{"issue":"4","key":"B21","series-title":"Am J Physiol Cell Mol Physiol","first-page":"L411","article-title":"Early life surfactant protein-D levels in bronchoalveolar lavage fluids of extremely preterm neonates","volume":"325","author":"De Luca D","year":"2023 Oct 1","unstructured":"De Luca D, Arroyo R, Foligno S, Autilio C, Touqui L, Kingma PS. Early life surfactant protein-D levels in bronchoalveolar lavage fluids of extremely preterm neonates. Am J Physiol Cell Mol Physiol [Internet]. 2023 Oct 1; 325(4): L411\u20138. Available from: https:\/\/journals.physiology.org\/doi\/10.1152\/ajplung.00079.2023."},{"issue":"3","key":"B22","series-title":"Zhongguo Dang Dai Er Ke Za Zhi","first-page":"285","article-title":"[Early use of calf pulmonary surfactant in late preterm and full-term infants with respiratory distress syndrome: a randomized controlled trial]","volume":"16","author":"Zhou WL","year":"2014 Mar","unstructured":"Zhou WL, Zhou Q, Li C, Wu H. [Early use of calf pulmonary surfactant in late preterm and full-term infants with respiratory distress syndrome: a randomized controlled trial]. Zhongguo Dang Dai Er Ke Za Zhi [Internet]. 2014 Mar; 16(3): 285\u20139. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24661523."}],"container-title":["Physiology International"],"original-title":[],"link":[{"URL":"https:\/\/www.akjournals.com\/view\/journals\/2060\/aop\/article-10.1556-2060.2026.00885\/article-10.1556-2060.2026.00885.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.akjournals.com\/downloadpdf\/journals\/2060\/aop\/article-10.1556-2060.2026.00885\/article-10.1556-2060.2026.00885.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T10:19:29Z","timestamp":1792059569000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.akjournals.com\/view\/journals\/2060\/aop\/article-10.1556-2060.2026.00885\/article-10.1556-2060.2026.00885.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":22,"URL":"https:\/\/doi.org\/10.1556\/2060.2026.00885","relation":{},"ISSN":["2498-602X","2677-0164"],"issn-type":[{"value":"2498-602X","type":"print"},{"value":"2677-0164","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]}}}