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A large dose is necessary in the presence of small and underdeveloped alveoli difficult to distend and maintain open, e.g. premature babies and newborns . Reduced doses are required in older children and adults due to the complete development of lung structure which does not tend to collapse easily.
Closure volume is high in the first 3 years and plays an important role in the quantity of surfactant required to stabilize terminal bronchiolus and alveoli reduced dose.
Lachmann B. Applied Cardiopulmonary Pathophys 1989
Marraro G, Foresti B, Casiraghi G, Riva A. In Bevilacqua G et al. Eds “Surfactant in clinical practice”. Harwood Acad Publish 1992
Lewis JF, Jobe AH. Am Rev Respir Dis 1993
Steinberg KP. Respir Care 1993
Marraro G. Minerva Anestesiol 1999