Animal-derived Surfactants for the Treatment and Prevention of Neonatal Respiratory Distress Syndrome: Summary of Clinical Trials

Overview

Journal Ther Clin Risk Manag

Publisher Dove Medical Press

Date 2009 May 14

PMID 19436610

Citations 13

Authors

J Wells Logan

Fernando R Moya

Affiliations

Soon will be listed here.

Abstract

Introduction: Available literature suggests that the advantage of animal-derived surfactants over first-generation synthetic agents derives from the presence of surface-active proteins and their phospholipid content. Here we summarize the results of clinical trials comparing animal-derived surfactant preparations with other animal-derived surfactants and with both first-and second-generation synthetic surfactants.

Methods: Published clinical trials of comparisons of animal-derived surfactants were summarized and compared. Comparisons emphasized differences in (1) key surfactant components attributed with efficacy and (2) differences in published outcomes.

Results: For the most important outcomes, mortality and chronic lung disease, currently available natural surfactants are essentially similar in efficacy. When examining secondary outcomes (pneumothorax, ventilator weaning, and need for supplemental oxygen), it appears that both calfactant and poractant have an advantage over beractant. The weight of the evidence, especially for study design and secondary outcomes, favors the use of calfactant. However, the superiority of poractant over beractant, when the higher initial dose of poractant is used, strengthens the case for use of poractant as well.

Conclusions: Clinical trials suggest that the higher surfactant protein-B content in calfactant, and perhaps the higher phospholipid content in poractant (at higher initial dose), are the factors that most likely confer the observed advantage over other surfactant preparations.

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References

Bloom B, Clark R . Comparison of Infasurf (calfactant) and Survanta (beractant) in the prevention and treatment of respiratory distress syndrome. Pediatrics. 2005; 116(2):392-9. DOI: 10.1542/peds.2004-2783. View

Moya F, Gadzinowski J, Bancalari E, Salinas V, Kopelman B, Bancalari A . A multicenter, randomized, masked, comparison trial of lucinactant, colfosceril palmitate, and beractant for the prevention of respiratory distress syndrome among very preterm infants. Pediatrics. 2005; 115(4):1018-29. DOI: 10.1542/peds.2004-2183. View

Modanlou H, Beharry K, Padilla G, Norris K, Safvati S, Aranda J . Comparative efficacy of exosurf and survanta surfactants on early clinical course of respiratory distress syndrome and complications of prematurity. J Perinatol. 1998; 17(6):455-60. View

. A multicenter, randomized trial comparing synthetic surfactant with modified bovine surfactant extract in the treatment of neonatal respiratory distress syndrome. Vermont-Oxford Neonatal Network. Pediatrics. 1996; 97(1):1-6. View

da Costa D, Pai M, Al Khusaiby S . Comparative trial of artificial and natural surfactants in the treatment of respiratory distress syndrome of prematurity: experiences in a developing country. Pediatr Pulmonol. 1999; 27(5):312-7. DOI: 10.1002/(sici)1099-0496(199905)27:5<312::aid-ppul3>3.0.co;2-n. View

Mazela J, Merritt T, Gadzinowski J, Sinha S . Evolution of pulmonary surfactants for the treatment of neonatal respiratory distress syndrome and paediatric lung diseases. Acta Paediatr. 2006; 95(9):1036-48. DOI: 10.1080/08035250600615168. View

Soll R, Morley C . Prophylactic versus selective use of surfactant for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2000; (2):CD000510. DOI: 10.1002/14651858.CD000510. View

Sinha S, Moya F, Donn S . Surfactant for respiratory distress syndrome: are there important clinical differences among preparations?. Curr Opin Pediatr. 2007; 19(2):150-4. DOI: 10.1097/MOP.0b013e328082e2d9. View

Speer C, Gefeller O, Groneck P, Laufkotter E, Roll C, Hanssler L . Randomised clinical trial of two treatment regimens of natural surfactant preparations in neonatal respiratory distress syndrome. Arch Dis Child Fetal Neonatal Ed. 1995; 72(1):F8-13. PMC: 2528411. DOI: 10.1136/fn.72.1.f8. View

10.

Soll R, Blanco F . Natural surfactant extract versus synthetic surfactant for neonatal respiratory distress syndrome. Cochrane Database Syst Rev. 2001; (2):CD000144. DOI: 10.1002/14651858.CD000144. View

11.

Malloy C, Nicoski P, Muraskas J . A randomized trial comparing beractant and poractant treatment in neonatal respiratory distress syndrome. Acta Paediatr. 2005; 94(6):779-84. DOI: 10.1111/j.1651-2227.2005.tb01984.x. View

12.

Moya F, Hoffman D, Zhao B, Johnston J . Platelet-activating factor in surfactant preparations. Lancet. 1993; 341(8849):858-60. DOI: 10.1016/0140-6736(93)93062-6. View

13.

Hammoud M, Al-Kazmi N, Alshemmiri M, Thalib L, Ranjani V, Devarajan L . Randomized clinical trial comparing two natural surfactant preparations to treat respiratory distress syndrome. J Matern Fetal Neonatal Med. 2004; 15(3):167-75. DOI: 10.1080/14767050410001668266. View

14.

Moya F, Maturana A . Animal-derived surfactants versus past and current synthetic surfactants: current status. Clin Perinatol. 2007; 34(1):145-77, viii. DOI: 10.1016/j.clp.2006.12.005. View

15.

Suresh G, Soll R . Lung surfactants for neonatal respiratory distress syndrome: animal-derived or synthetic agents?. Paediatr Drugs. 2002; 4(8):485-92. DOI: 10.2165/00128072-200204080-00001. View

16.

Pfister R, Soll R . New synthetic surfactants: the next generation?. Biol Neonate. 2005; 87(4):338-44. DOI: 10.1159/000084882. View

17.

Kukkonen A, Virtanen M, Jarvenpaa A, Pokela M, Ikonen S, Fellman V . Randomized trial comparing natural and synthetic surfactant: increased infection rate after natural surfactant?. Acta Paediatr. 2000; 89(5):556-61. DOI: 10.1080/080352500750027853. View

18.

Jadad A, Moore R, Carroll D, Jenkinson C, Reynolds D, Gavaghan D . Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials. 1996; 17(1):1-12. DOI: 10.1016/0197-2456(95)00134-4. View

19.

Ainsworth S, Beresford M, Milligan D, Shaw N, Matthews J, Fenton A . Pumactant and poractant alfa for treatment of respiratory distress syndrome in neonates born at 25-29 weeks' gestation: a randomised trial. Lancet. 2000; 355(9213):1387-92. DOI: 10.1016/s0140-6736(00)02136-x. View

20.

Baroutis G, Kaleyias J, Liarou T, Papathoma E, Hatzistamatiou Z, Costalos C . Comparison of three treatment regimens of natural surfactant preparations in neonatal respiratory distress syndrome. Eur J Pediatr. 2003; 162(7-8):476-480. DOI: 10.1007/s00431-002-1144-0. View