Abstract
The benefits of exogenous synthetic or animal-derived surfactants for prevention or treatment of respiratory distress syndrome (RDS) are well established. Data from head-to-head trials comparing animal-derived surfactants primarily with the synthetic surfactant colfosceril suggest that the major clinical advantages afforded by the presence of surfactant protein (SP)-B and SP-C in animal-derived preparations relate to faster onset of action, a reduction in the incidence of RDS when used prophylactically, and a lower incidence of air leaks and RDS-related deaths. However, no benefits in terms of overall mortality or BPD have been shown in these head-to-head comparisons. Findings from trials of a new-generation synthetic surfactant containing a peptide that mimics SP-B, as well as their follow-up study suggest that its administration improves short-term clinical outcomes compared with colfosceril and results in survival through 1 year of age, which is at least comparable, if not perhaps superior, to that seen with animal-derived surfactants.
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References
Ainsworth SB, Milligan DW . Surfactant therapy for respiratory distress syndrome in premature neonates: a comparative review. Am J Respir Med 2002; 1: 417–433.
Soll RF, Blanco F . Natural surfactant extract versus synthetic surfactant for neonatal respiratory distress syndrome. Cochrane Database Syst Rev 2001; (2) Art. No.: CD000144.
Curstedt T, Jörnvall H, Robertson B, Bergman T, Berggren P . Two hydrophobic low-molecular-mass protein fractions of pulmonary surfactant: characterization and biophysical activity. Eur J Biochem 1987; 168: 255–262.
Notter RH, Wang Z, Egan EA, Holm BA . Component-specific surface and physiological activity in bovine-derived lung surfactants. Chem Phys Lipids 2002; 114: 21–34.
Clark JC, Wert SE, Bachurski CJ, Stahlman MT, Stripp BR, Weaver TE et al. Targeted disruption of the surfactant protein B gene disrupts surfactant homeostasis, causing respiratory failure in newborn mice. Proc Natl Acad Sci USA 1995; 92: 7794–7798.
Nogee LM, Garnier G, Dietz HC, Singer L, Murphy AM, deMello DE et al. A mutation in the surfactant protein B gene responsible for fatal neonatal respiratory disease in multiple kindreds. J Clin Invest 1994; 93: 1860–1863.
Nogee LM, Dunbar III AE, Wert SE, Askin F, Hamvas A, Whitsett JA . Brief report: a mutation in the surfactant protein C gene associated with familial interstitial lung disease. N Engl J Med 2001; 344: 573–579.
Cochrane CG, Revak SD . Pulmonary surfactant protein B (SP-B): structure-function relationships. Science 1991; 254: 566–568.
Moya F, Maturana A . Animal-derived surfactants versus past and present synthetic surfactants: current status. Clin Perinatol 2007; 34: 145–177.
Horbar JD, Wright LL, Soll RF, Wright EC, Fanaroff AA, Korones SB et al. A multicenter randomized trial comparing two surfactants for the treatment of neonatal respiratory distress syndrome. J Pediatr 1993; 123: 757–766.
Sehgal SS, Ewing CK, Richards T, Taeusch HW . Modified bovine surfactant (Survanta) versus a protein-free surfactant (Exosurf) in the treatment of respiratory distress syndrome in preterm infants: a pilot study. J Natl Med Assoc 1994; 86: 46–52.
Vermont-Oxford Neonatal Network. A multicenter, randomized trial comparing synthetic surfactant with modified bovine surfactant extract in the treatment of neonatal respiratory distress syndrome. Pediatrics 1996; 97: 1–6.
Modanlou HD, Beharry K, Padilla G, Norris K, Safvati S, Aranda JV . Comparative efficacy of Exosurf and Survanta on early clinical course of respiratory distress syndrome and complications of prematurity. J Perinatol 1997; 17: 455–460.
da Costa DE, Pai MGK, Al Kusaiby SM . 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: 312–317.
Moya FR, Gadzinowski J, Bancalari E, Salinas V, Kopelman B, Bancalari A et al., for the International Surfaxin Collaborative Study Group. 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: 1018–1029.
Hudak ML, Martin DJ, Egan EA, Matteson EJ, Cummings J, Jung AL et al. A multicenter randomized masked comparison trial of synthetic surfactant versus calf lung surfactant extract in the prevention of neonatal respiratory distress syndrome. Pediatrics 1997; 100: 39–50.
Hudak ML, Farrell EE, Rosenberg AA, Jung AL, Auten RL, Durand DJ et al. A multicenter randomized, masked comparison trial of natural versus synthetic surfactant for the treatment of respiratory distress syndrome. J Pediatr 1996; 128: 396–406.
Kukkonen AK, Virtanen M, Järvenpää A-L, Pokela ML, Ikonen S, Fellman V . Randomized trial comparing natural and synthetic surfactant: increased infection rate after natural surfactant? Acta Paediatr 2000; 89: 556–561.
Ainsworth SB, Beresford MW, Milligan DWA, Shaw N, Matthews J, Fenton A et al. Pumactant and poractant alfa for treatment of respiratory distress syndrome in neonates born at 25 to 29 weeks' gestation: a randomised trial. Lancet 2000; 355: 1387–1392.
Andersson S, Kheiter A, Merritt TA . Oxidative inactivation of surfactants. Lung 1999; 177: 179–189.
Revak SD, Merritt TA, Cochrane CG, Heldt GP, Alberts MS, Anderson DW et al. Efficacy of synthetic peptide-containing surfactant in the treatment of respiratory distress syndrome in preterm infant rhesus monkeys. Pediatr Res 1996; 39: 715–724.
Cochrane CG, Revak SD, Merritt TA, Heldt GP, Hallman M, Cunningham MD et al. The efficacy and safety of KL4-surfactant in preterm infants with respiratory distress syndrome. Am J Respir Crit Care Med 1996; 153: 404–410.
Sinha SK, Lacaze-Masmonteil T, Valls i Soler A, Wiswell TE, Gadzinowski J, Hajdu J et al., for the Surfaxin Therapy Against Respiratory Distress Syndrome Collaborative Group. A multicenter, randomized, controlled trial of lucinactant versus poractant alfa among very preterm infants at high risk for respiratory distress syndrome. Pediatrics 2005; 115: 1030–1038.
Moya F, Sinha S, Gadzinowski J, D'Agostino R, Segal R, Guardia C et al. SELECT and STAR Study Investigators. One-year follow up of very preterm infants who received lucinactant for prevention of respiratory distress syndrome: results from 2 multicenter, randomized, controlled trials. Pediatrics 2007; 119: e1361–e1370.
Kattwinkel J . Synthetic surfactants: the search goes on. Pediatrics 2005; 115: 1075–1076.
Halliday HH . Surfactants: past, present and future. J Perinatol 2008; 28: S47–S56.
Engle WA, the Committee on Fetus and Newborn. Surfactant-replacement therapy for respiratory distress in the preterm and term neonate. Pediatrics 2008; 121: 419–432.
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Moya, F. Synthetic surfactants: where are we? Evidence from randomized, controlled clinical trials. J Perinatol 29 (Suppl 2), S23–S28 (2009). https://doi.org/10.1038/jp.2009.26
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