Abstract.
The aim of the study was to compare the treatment regimen of three natural surfactants of different extraction and formulation (Alveofact [Surfactant A = SA], Poractant [Surfactant B = SB] and Beractant [Surfactant C = SC]) in neonatal respiratory distress syndrome (RDS). Premature infants of ≤32 weeks' gestation with birth weight of ≤2,000 g and with established RDS requiring artificial ventilation with a FiO2 ≥0.3 were randomly assigned to receive at least two doses of SA, SB or SC (100 mg/kg per dose). Infants who remained dependent on artificial ventilation with a FiO2 ≥0.3 received up to two additional doses. There were no differences among the groups regarding the necessity for more than two doses. The SA and the SB groups spent fewer days on a ventilator (p-value SA/SB 0.7, SA/SC 0.05, SB/SC 0.043) compared with the SC group, needed fewer days of oxygen administration (p-value SA/SB 0.14, SA/SC 0.05, SB/SC 0.04) and spent fewer days in hospital (p-value SA/SB 0.65, SA/SC 0.04, SB/SC 0.027). There were no statistically significant differences in the incidence of mortality, chronic lung disease, air leaks, necrotising enterocolitis, retinopathy of prematurity and intraventricular haemorrhage among the three groups. Conclusion: the Alveofact and Poractant groups spent fewer days on the ventilator, needed fewer days of oxygen administration and spent fewer days in hospital compared with the Beractant group but no differences were observed among the three groups with regards to mortality and morbidity.
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Abbreviations
- RDS:
-
respiratory distress syndrome
- SA:
-
surfactant A (Alveofact)
- SB:
-
surfactant B (Poractant)
- SC:
-
surfactant C (Beractant)
- OI:
-
oxygenation index
- VEI:
-
ventilatory efficiency index
- CLD:
-
chronic lung disease
- PDA:
-
patent ductus arteriosus
- NEC:
-
necrotising enterocolitis
- ROP:
-
retinopathy of prematurity
- IVH:
-
intraventricular haemorrhage
References
Bartlett RH, Toomasian J, Roloff D, Gazzaniga AB, Gorwin HG, Rucker R (1986) Extracorporeal membrane oxygenation (ECMO) in neonatal respiratory failure. Ann Surg 204:236–245
Bell MJ, Ternberg JL, Feigin RD (1987) Neonatal necrotizing enterocolitis: therapeutic decisions based upon clinical staging. Ann Surg 187:1–7
Bloom BT, Kattwinkel J, Hall RT, Delmore PM, Egan EA, Trout JR, Malloy MH, Brown DR, Holzman IR, Coghill CH, Waldemar AC, Pramanik AK, McCaffree MA, Toubas PL, Laudert S, Granty LL, Weatherstone KB, Seguin JH, Willett LD, Gutcher GR, Mueller DH, Topper WH (1997) Comparison of Infasurf (calf lung surfactant extract) to Survanta (Beractant) in the treatment and prevention of respiratory distress syndrome. Pediatrics 100:31–38
Clark RH, Auten RL, Peadody J (2001) A comparison of the outcomes of neonates treated with two different natural surfactants. J Pediatr 139:828–831
Committee for the Classification of Retinopathy of Prematurity II (1987) The classification of retinal detachment. Arch Ophthalmol 105:906–912
Cummings J, Holm B, Hudak B, Ferguson W, Egan E (1992) A controlled clinical comparison of four different surfactant preparations in surfactant-deficient preterm lambs. Am Rev Respir Dis 145:999–1004
Egan EA, Holm BA, Hiavaty LM, Egan ES (1993) Cell wall phospholipids and lung biophysics. Am Rev Respir Dis 147:A987
Hall SB, Venkitaraman AR, Whitsett JA, Holm BA, Notter RH (1992) Importance of hydrophobic apoproteins as constituents of clinical exogenous surfactants. Am Rev Respir Dis 145:24–30
Horbar JD, Wright LL, Soll RF, Wright EC, Fanaroff AA, Korones SB, Shankaran S, Oh W, Fletcher BD, Bauer CR (1993) Multicenter randomized trial comparing two surfactants for the treatment of neonatal respiratory distress syndrome. J Pediatr 123:757–766
Hudak ML, Farrell EE, Rosenberg AA, Jung AL, Aulen RL, Durand DJ, Horgan MJ, Buckwald J, Belcastro MR, Donohue PK, Carrion V, Maniscalco WW, Balsan MJ, Torres BA, Miller RR, Tansen RD, Graeber JE, Laskay KM, Matteson EJ, Egan EA, Brody A, Martin DJ, Riddlesberger MM, Montogomery P (1996) A multicenter randomized, masked comparison trial of natural versus synthetic surfactant for the treatment of respiratory distress syndrome. J Pediatr 128:396–406
Jobe AH (1993) Pulmonary surfactant therapy. N Engl J Med 328:861–868
Mizuno K, Ikegami M, Chen CM, Ueda T, Jobe AH (1995) Surfactant protein-B supplementation improves in vivo function of a modified natural surfactant. Pediatr Res 37:271–276
Papile L, Burstein J, Burstein R, Koffler H (1978) Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birthweight less than 1500 grams. J Pediatr 92:529–534
Seeger W, Grube C, Gunher A, Schmidt R (1993) Surfactant inhibition by plasma proteins: differential sensitivity of various surfactant preparations. Eur Respir J 6:971–977
Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM (1982) Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics 82:527–532
Speer CP, Reuv D, Harms K, Herting E, Gefeller O (1993) Neutrophil elastase and acute pulmonary damage in infants with severe respiratory distress syndrome. Pediatrics 91:794–799
Speer CP, Gefeller O, Groneck P, Laufkötter E, Roll C, Hanssler L, Harms K, Herting E, Boenisch H, Windeler J, Robertson B (1995) Randomized clinical trial of two treatment regimens of natural surfactant preparations in neonatal respiratory distress syndrome. Arch Dis Child 72:F8–F13
Ueda T, Ikegami M, Rider ED, Jobe AH (1994) Distribution of surfactant and ventilation in surfactant treated preterm lambs. J Appl Physiol 56:45–55
Vermont Oxford Neonatal Network (1995) A multicenter, randomized trial comparing synthetic surfactant with bovine surfactant in the treatment of neonatal respiratory distress syndrome. Pediatrics 97:1–6
Wang Z, Gurel O, Baatz JE, Notter RH (1996) Differential activity and lack of synergy of lung surfactant proteins SP-B and SP-C in interactions with phospholipids. J Lipid Res 37:1749–1760
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Baroutis, G., Kaleyias, J., Liarou, T. et al. Comparison of three treatment regimens of natural surfactant preparations in neonatal respiratory distress syndrome. Eur J Pediatr 162, 476–480 (2003). https://doi.org/10.1007/s00431-002-1144-0
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DOI: https://doi.org/10.1007/s00431-002-1144-0