Poractant alfa and beractant treatment of very premature infants with respiratory distress syndrome

Abstract

Objective: Comparison of the differences between availability of animalderived surfactant preparations used to treat premature infants is incomplete. The objective of this study was to assess the short-term treatment efficacy of the two most commonly used surfactant preparations in the United States, beractant (100 mg kg Result: We studied 52 infants 24 0/7 to 29 6/7 weeks gestation; 25 received poractant alfa (27.1±1.6 weeks, birth weight of 930±231 g) and 27 received beractant (26.7 ± 1.7 weeks, P ¼ 0.343 and birth weight 900 ± 271 g, P ¼ 0.668). Respiratory support for the first 72 h of life was lower in the poractant alfa than beractant group for mean airway pressure (MAP, P ¼ 0.003) and respiratory index (MAP Â FiO 2 , P ¼ 0.032). Infants in the poractant alfa group had a greater number of infants extubated at 48 (13/25 vs 6/27, P ¼ 0.027) and 72 h (15/25 vs 8/27, P ¼ 0.029) than the beractant group. Although the study was not powered to detect morbidities of prematurity, the prevalence of PDA and air leaks was less in the infants treated with poractant alfa than in those treated with beractant. Rates of bronchopulmonary dysplasia (8/23 vs 11/ 22, P ¼ 0.303) or death (2/15 vs 5/27, P ¼ 0.272) were similar in the infants treated with poractant alfa and beractant, respectively. Conclusion:This study suggests significant short-term benefits to the use of the larger initial dose of poractant alfa than beractant in very premature infants with RDS. Further studies involving a larger number of preterm infants are needed to assess long-term effects.

Patent ductus arteriosus hemodynamics in very premature infants treated with poractant alfa or beractant for respiratory distress syndrome

“…More infants in the poractant alfa group were extubated at 48 and 72 h (*P<0.05). (6). Thus, there was a difference in the PDA management and hemodynamics in infants treated with poractant alfa, compared with beractant that was associated with improvement in respiratory status.…”

“…These differences were associated with a more rapid and sustained improvement in respiratory function in the poractant alfa group, allowing more elective extubations at 48 and 72 h than in the beractant group. 6 We did not demonstrate a direct surfactant effect on PDA closure or PDA hemodynamics by echocardiographic evaluation following the second dose of poractant alfa or beractant. Since PDAs tended to be treated earlier in the poractant alpha group, yet there were more PDAs treated in the beractant group, it is unlikely that early treatment of PDAs that would have close spontaneously, accounted for the lower number of PDAs treated in the poractant alfa group.…”

“…6,25 Improved oxygenation may increase PDA closure rates. 26 Higher levels of positive pressure mechanical ventilation in the beractant group, compared with the poractant alfa group, may have stimulated a chronic inflammatory response that has been associated with development of chronic lung disease and PDAs through activation of the inflammatory cascade and prostaglandin synthesis.…”

Non-Invasive Ventilation and Surfactant Therapy

“…Faster weaning of oxygen and mean airway pressure was reported with CA compared to BE, and no differences in the need for additional doses, mortality or any other clinical outcomes were seen [84,85]. In contrast, comparison of porcine surfactant PA, with bovine surfactant BE from 6 randomized trials, showed faster weaning of oxygen, faster weaning of PIP and mean airway pressure, fewer air leaks, less need for additional doses, less patent ductus arteriosus, less patients on invasive ventilation after 72 hours, and decreased the incidence of BPD and also reduced mortality [86][87][88][89][90][91]. Clark et al [92] reported no difference in mortality between BE and CA in a retrospective study of 5,169 patients.…”

Eficacia de tres tipos de surfactante exógeno en prematuros con enfermedad de membrana hialina

“…No se logró demostrar diferencias para los otros parámetros de ventilación y de oxigenación. Otros autores, demostraron diferencias significativas en la presión media de la vía aérea favoreciendo al poractant alfa al compararlo con beractant 10,11 , la cual fue menor entre las primeras 24-72 h. Singh N y cols. 6 , informan en su meta-análisis una disminución de los requerimientos de O 2 para el poractant alfa a 200 mg/kg cuando se le comparó con beractant 100 mg/kg.…”