Natural vs synthetic surfactants in neonatal respiratory distress syndrome

被引:49
作者
Halliday, HL [1 ]
机构
[1] QUEENS UNIV BELFAST, DEPT CHILD HLTH, BELFAST BT7 1NN, ANTRIM, NORTH IRELAND
关键词
D O I
10.2165/00003495-199651020-00004
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
This review examines the 11 randomised clinical trials that have compared different surfactant preparations. Seven trials, enrolling 2488 infants with respiratory distress syndrome (RDS), compared the natural surfactant beractant (Survanta(R)) with the synthetic surfactant colfosceril palmitate (Exosurf(R) Neonatal(R)). Infants treated with beractant had lower oxygen requirements for at least 3 days than those treated with colfosceril palmitate. The infants treated with beractant also had lower risks of neonatal mortality [odds ratio (OR) 0.81; 95% confidence interval (CI) 0.65 to 1.01], retinopathy of prematurity (OR 0.81; 95% CI 0.66 to 0.99), and the combined endpoint of death or bronchopulmonary dysplasia (OR 0.86; 95% CI 0.75 to 0.99), compared with those treated with colfosceril palmitate. Calflung surfactant extract (CLSE; Infasurf(R)), another natural surfactant, has been compared with colfosceril palmitate in 2 studies: in one as prophylaxis and in the other as rescue therapy. Similar, although nonsignificant, advantages were found for the natural surfactant compared with the synthetic surfactant. In 6 of these 9 trials there was a significant reduction in the odds of pulmonary air leaks (OR 0.53; 95% CI 0.41 to 0.64) for infants treated with natural compared with synthetic surfactants. In 7 trials (3554 infants) comparing natural and synthetic surfactants to-treat RDS (6 comparing beractant and colfosceril palmitate, and one CLSE and colfosceril palmitate), there was a significantly reduced risk of neonatal mortality (OR 0.80; 95% CI 0.66 to 0.97) with natural compared with synthetic surfactant treatment. In 2 further trials, different natural surfactant preparations have been compared. Reduced oxygen needs for 24 hours after treatment were found for CLSE and Curosurf(R) (porcine-derived lung surfactant, PLS) when each was compared with beractant. Apparent longer term benefits from these surfactants were not statistically proven. Further trials are needed to be certain of the differences between the various surfactant preparations.
引用
收藏
页码:226 / 237
页数:12
相关论文
共 47 条
[21]   EXOGENOUS HUMAN SURFACTANT FOR TREATMENT OF SEVERE RESPIRATORY-DISTRESS SYNDROME - A RANDOMIZED PROSPECTIVE CLINICAL-TRIAL [J].
HALLMAN, M ;
MERRITT, TA ;
JARVENPAA, AL ;
BOYNTON, B ;
MANNINO, F ;
GLUCK, L ;
MOORE, T ;
EDWARDS, D .
JOURNAL OF PEDIATRICS, 1985, 106 (06) :963-969
[22]   A MULTICENTER RANDOMIZED TRIAL COMPARING 2 SURFACTANTS FOR THE TREATMENT OF NEONATAL RESPIRATORY-DISTRESS SYNDROME [J].
HORBAR, JD ;
WRIGHT, LL ;
SOLL, RF ;
WRIGHT, EC ;
FANAROFF, AA ;
KORONES, SB ;
SHANKARAN, S ;
OH, W ;
FLETCHER, BD ;
BAUER, CR ;
TYSON, JE ;
LEMONS, JA ;
DONOVAN, EF ;
STOLL, BJ ;
STEVENSON, DD ;
PAPILE, LA ;
PHILIPS, J ;
POLAND, RL ;
TSANG, RC ;
LITTLE, G ;
BAIN, RP ;
FOLEY, KA ;
BANDSTRA, E ;
MALLOY, M ;
KENNEDY, K ;
OSTREA, E ;
EHRENKRAN, R ;
HACK, M ;
EDWARDS, W ;
BRUMLEY, GW ;
YOUNES, N ;
DENNE, SC ;
YAFFE, SJ ;
BADA, H ;
LUCEY, JF ;
STONESTREET, B ;
GROSS, I .
JOURNAL OF PEDIATRICS, 1993, 123 (05) :757-766
[23]  
HUDAK ML, 1994, PEDIATR RES, V35, P231
[24]  
JOBE AH, 1993, NEW ENGL J MED, V328, P861
[25]   THE PROTEINS OF THE SURFACTANT SYSTEM [J].
JOHANSSON, J ;
CURSTEDT, T ;
ROBERTSON, B .
EUROPEAN RESPIRATORY JOURNAL, 1994, 7 (02) :372-391
[26]  
MODANLOU H, 1994, PEDIATR RES, V35, pA242
[27]  
MODANLOU HD, 1994, PEDIATR RES, V35, pA345
[28]  
MORLEY CJ, 1981, LANCET, V1, P64
[29]   INCIDENCE AND EVOLUTION OF SUBEPENDYMAL AND INTRA-VENTRICULAR HEMORRHAGE - STUDY OF INFANTS WITH BIRTH WEIGHTS LESS THAN 1,500 GM [J].
PAPILE, LA ;
BURSTEIN, J ;
BURSTEIN, R ;
KOFFLER, H .
JOURNAL OF PEDIATRICS, 1978, 92 (04) :529-534
[30]  
PEARLMAN SA, 1993, PEDIATR RES, V33, P340