One of the frequent causes of respiratory failure in infants is bronchiolitis but yet no effective therapy is available.1 A major clinical study led by UK researchers has found that a commonly used treatment to support breathing in premature infants does not offer any benefit for critically ill babies with severe bronchiolitis who require life support. The findings were presented at the 34th International Congress of the European Society for Paediatric and Neonatal Intensive Care (ESPNIC) held in Alicante, Spain.
Bronchiolitis is a seasonal viral lung infection, most often caused by respiratory syncytial virus (RSV), that leads to hospital admission in thousands of infants each year. While it usually resolves with supportive care like oxygen and fluids, it can become severe in babies under one year old—particularly those born prematurely. In these cases, infants may need intensive care and mechanical ventilation. Since surfactant—a substance that helps the lungs stay open—is often lacking in both premature babies and those with bronchiolitis, researchers wanted to test whether giving surfactant would help critically ill infants recover more quickly.
The study, known as the BESS trial2, is the largest randomized trial to date investigating the use of surfactant in bronchiolitis. It was conducted over six winter seasons, from 2019 to 2024, across 15 paediatric hospitals in England, Scotland, and Northern Ireland. A total of 232 severely ill infants participated in the trial. Although the treatment was found to be safe, it did not shorten the duration needed for mechanical ventilation in those babies. Although smaller trials prior to BESS—comprising a total of 79 infants—suggested potential benefits of surfactant (including improved oxygenation, reduced carbon dioxide, shorter ICU stays, and a non-significant trend toward reduced ventilation time), they were limited by small sample sizes and heterogeneous protocols.3
The study's lead investigator from the University of Liverpool and Alder Hey Children’s NHS Foundation Trust explained that while researchers had hoped surfactant would help speed up recovery, the data did not show any improvement in ventilation time. As a result, routine use of surfactant in these patients is not recommended.
Bronchiolitis remains the most common reason for infant hospital admissions during the UK winter months. Of the approximately 25,000 babies hospitalized annually, around 1,000 require intensive care support. With no specific antiviral treatment for RSV or bronchiolitis currently available, supportive care remains the mainstay of management.
The research team emphasized that surfactant therapy continues to be vital for premature infants, but not for those with bronchiolitis on life support. They advocate for continued research into better treatments and encourage expectant mothers to receive the RSV vaccine during pregnancy to protect their newborns from severe illness.
References :
- Jat KR, Chawla D. Surfactant therapy for bronchiolitis in critically ill infants. Cochrane Database Syst Rev. 2015 Aug 24;2015(8):CD009194. doi: 10.1002/14651858.CD009194.pub3. PMID: 26299681; PMCID: PMC7104667
- https://www.bess-trial.org.uk
- https: //doi.org/10.1186/ISRCTN11746266
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