Comparison of the Efficacy of Three Natural Surfactants (Curosurf, Survanta, and Alveofact) in the Treatment of Respiratory Distress Syndrome Among Neonates: A Randomized Controlled Trial

Abstract

BackgroundAlthough several different types of natural surfactants are available, including Alveofact, Curosurf, and Survanta, the preferred type and the magnitude of their effects are unknown.ObjectivesThis study was designed to compare the effects of these three surfactants on the gas exchange and clinical outcomes of neonates with respiratory distress syndrome (RDS).MethodsThis triple-blind randomized clinical trial studied all preterm neonates ≤ 37 weeks with RDS who were admitted to the neonatal intensive care unit (NICU) of Taleghani hospital (Tabriz, Iran) between 2012 and 2013. The patients were divided into three groups, each of which received one of these surfactants. The incidences of ventilator dependency, patent ductus arteriosus (PDA), broncho-pulmonary dysplasia (BPD), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH), hospital-stay length, and continuous positive airway pressure (CPAP) failure, as well as blood gas levels, were recorded as endpoint measurements and compared.ResultsIn total, 165 neonates of gestational age ≤ 37 weeks with RDS were examined. Neonates were allocated to three different groups randomly, including a Survanta group (n = 49), a Curosurf group (n = 62), and an Alveofact group (n = 54). The mean gestational age of the neonates was 31.6 ± 3.7 weeks, and their mean weight was 1,840 ± 790 grams. The male/female ratio was 2:1 (67% male, 33% female); 104 (63%) neonates were ≤ 32 weeks gestational age, and 61 (37%) were >32 weeks. There were no significant differences for gender or demographic characteristics among the neonates in relation to the type of applied surfactant. According to the clinical parameters (BPD, IVH, ROP, hospital-stay length, and mechanical ventilation requirement), no significant differences were observed between the groups before and after surfactant administration, but the differences between the Survanta and Alveofact groups for the incidence rates of pneumothorax (P = 0.03) and pulmonary hemorrhage (P = 0.03) were statistically significant.ConclusionsNo significant differences were observed in most of the clinical variables between the three types of natural surfactant, but in neonates ≤ 32 weeks, the incidence of pneumothorax was significantly higher in the Alveofact group; in neonates > 32 weeks, the incidences of PDA, mean hospital-stay length, and mean mechanical ventilation time were also significantly higher in the same group. It thus appears that Curosurf and Survanta replacement therapies among premature neonates with RDS perform better than Alveofact replacement therapy.

The Impact of Nonequilibrium Conditions in Lung Surfactant: Structure and Composition Gradients in Multilamellar Films

“… 13 , 14 In the present study, we have used samples composed of the clinical surfactant replacement Curosurf, which is commonly used in surfactant replacement therapies in clinics throughout the world. 6 Curosurf is composed of water-insoluble lipids and is therefore formulated as a multilamellar vesicle dispersion in water. Curosurf has like other clinical extracts a much lower cholesterol (0–1 wt %) 15 and protein content (no SP-A or SP-D, less SP-B and SP-C) 14 than the endogenous lung surfactant.…”

In Vivo Evaluation of the Acute Pulmonary Response to Poractant Alfa and Bovactant Treatments in Lung-Lavaged Adult Rabbits and in Preterm Lambs with Respiratory Distress Syndrome

“…Retrospective studies of these trials indicate that Poractant alfa significantly reduced the mortality compared to Beractant or Calfactant administered at doses of 100 and 105 mg/kg, respectively, provided that Poractant alfa was administered at a dose of 200 mg/kg ( 15 , 16 ). Unfortunately, the scarce clinical trials comparing Bovactant and Poractant alfa are inconclusive and of a relatively low sample size to draw a definitive conclusion ( 8 , 17 , 18 ). Moreover, to date, no preclinical data were available which directly compares the acute effects on the overall lung function of these two surfactant preparations, which this study provides.…”

“…The comparison of the efficacy of Bovactant and Poractant alfa, two clinically available surfactant preparations, has not led yet to conclusive and univocal recommendations in the clinical arena ( 8 , 15 , 17 , 18 ). Differences between Poractant alfa and Bovactant include the animal source (porcine vs. bovine), the extraction method (minced lung vs. lung wash), the pharmaceutical form (suspension vs. powder), the phospholipid and protein concentration and composition (a detailed description is available in Section “ Surfactant Preparations ”), and their licensed doses (100 or 200 mg/kg for Poractant alfa vs. 50 mg/kg for Bovactant) ( 14 ).…”

Porcine versus bovine surfactant therapy for RDS in preterm neonates: pragmatic meta-analysis and review of physiopathological plausibility of the effects on extra-pulmonary outcomes

“…Additionally, we also searched PubMed, using key words and/or MeSH terms as described in the Additional file 1, looking for animal or human translational investigations on these mechanisms. Fig.1 illustrates the project flow-chart: we included 17 studies in the systematic review [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] and we excluded two papers from the meta-analysis, as they investigated two non-internationally marketed porcine surfactants [43,44]. Compared to our previous metaanalysis on respiratory endpoints, there was one more study reporting on the extra-pulmonary outcomes [45].…”