Several theories tried to explain the etiology of PAR.
Infection, one of the theories, can affect the surfactant system
leading to surfactant deficiency through several mechanisms
including inflammatory cytokines produced in response to
sepsis inhibiting the synthesis of surfactant.14 Activated
neutrophils are capable of cleaving SP-A and impairing
surfactant function.15 Sayed et al reported that abnormal
surfactant function in the larger airwaysmight be expected to
decrease the efficiency of mucociliary clearance and also
adversely lead to stasis of mucus.1