Surfactant Therapy Fails to Help Ventilated Infants with Severe Bronchiolitis, UK Trial Finds

A major UK clinical trial has found that surfactant therapy does not improve outcomes for infants with severe bronchiolitis on ventilators. The study, known as the BESS trial, tested whether the treatment could shorten the time babies needed mechanical breathing support. Each year, around 25,000 UK infants are hospitalised with RSV-related bronchiolitis, with roughly 1,000 requiring invasive ventilation.

The trial was led by UK researchers and involved infants with severe bronchiolitis who needed mechanical ventilation. Surfactant, a substance that helps keep lungs inflated, is already used to treat premature babies with underdeveloped lungs. However, the BESS trial confirmed that while the therapy was safe, it did not reduce the duration of ventilation or change the clinical course of bronchiolitis.

The findings highlight a key challenge in neonatal medicine: therapies effective for one lung condition do not always work for others. This outcome discourages unnecessary surfactant use in bronchiolitis, helping conserve medical resources and ensuring treatments align with evidence-based practice. Currently, severe bronchiolitis management remains supportive, as no drug has been proven to alter the disease's progression in critically ill patients. The trial also underscores the need for deeper research into bronchiolitis mechanisms beyond surfactant deficiency. Meanwhile, preventative strategies like maternal RSV vaccination offer potential to reduce both the incidence and severity of the disease. Collaborative research networks, including the Medical Research Council (MRC) and the National Institute for Health and Care Research (NIHR), played a vital role in conducting the trial. These infrastructures help turn biomedical discoveries into practical clinical solutions.

The BESS trial provides clear evidence that surfactant therapy does not benefit ventilated infants with bronchiolitis. This result helps clinicians avoid ineffective treatments and focus on proven supportive care. Future research will now explore alternative approaches, including preventative measures and deeper investigations into the disease's underlying causes.