Background: Bronchopulmonary Dysplasia (BPD) is a common chronic lung disease of preterm infants associated with adverse respiratory and neurological outcomes and increased mortality. Inhaled tauractant (Surfactant-BL), a natural bovine surfactant, has been proposed as a new preventive approach, but evidence of its effectiveness is lacking.

Objective: To evaluate the effect of inhaled tauractant on clinical and lung ultrasound characteristics of respiratory status in newborns at risk of BPD.

Methods: This single-center prospective observational study was conducted at the Yekaterinburg Clinical Perinatal Center (January 2024 – December 2025). Thirty-one infants born at <30 weeks of gestation (median 26 weeks, birth weight 900 g) who required nasal continuous positive airway pressure (CPAP, n = 17) or mechanical ventilation (MV, n = 14) on days 8–14 of life received five daily inhalations of tauractant 75 mg via a vibrating-mesh nebulizer. Lung ultrasound scores (LUS, 12 zones, 0–36 points) were recorded daily before and 30 minutes after each inhalation.

Results: Respiratory support changed in 10 infants during the course: de-escalation in 9 (in 6 within the first 1–2 days) and intubation in one. The number of infants on low-flow nasal cannula increased from 0 to 5 (p = 0.026). In the whole cohort, the median LUS decreased from 23 to 21 (p < 0.001). In the CPAP group, LUS fell from 22 to 16 (p < 0.001), whereas in the MV group it did not change (24 vs 24.5, p = 0.693). FiO2 did not change significantly in either group.

Conclusion: A five-day course of inhaled tauractant in preterm infants at risk of BPD was associated with early de-escalation of respiratory support and marked improvement in lung aeration in infants on nasal CPAP, with no pronounced effect in those on MV. Controlled trials are needed to confirm these findings.

Vsevolod S. Makarov, is an anesthesiologist-intensivist in the Neonatal Intensive Care Unit of the Yekaterinburg Clinical Perinatal Center, Assistant at the Department of Neonatology and Head of the Laboratory of Instrument Engineering for Critical Care Medicine at Ural State Medical University (Yekaterinburg, Russian Federation). His clinical and research interests include respiratory support of preterm infants, inhaled surfactant therapy, neonatal lung ultrasound, and the development of medical devices and simulators for neonatal intensive care.