Unbound MEDLINE

Animal-derived surfactants versus past and current synthetic surfactants: current status.

Abstract

In this review, the authors assess major outcomes resulting from head-to-head comparison trials of animal-derived surfactants with previous and newer synthetic surfactants and among them. They also pay special attention to issues of study design and quality of the trials reviewed. Animal-derived surfactants that contain surfactant proteins (Survanta, Infasurf, and Curosurf) perform clinically better than Exosurf, a synthetic surfactant containing only phospholipids, primarily in outcomes related to acute management of respiratory distress syndrome (RDS; faster weaning and pneumothorax) but not in overall mortality or incidence of bronchopulmonary dysplasia (BPD). Trials comparing various animal-derived surfactants that provide different amounts of surface protein B (SP-B) or phospholipids have shown minor differences in outcomes related to the management of RDS or none at all. The exception is the suggestion of better survival using a high initial dose of Curosurf when compared with Survanta. This observation is based on analysis of trials of relatively lesser quality that have included a smaller number of infants than other surfactant comparisons, however. Data from recent trials comparing a new-generation synthetic surfactant that contains a peptide mimicking the action of SP-B, Surfaxin, have shown that it performs better than Exosurf (faster weaning and less BPD) and at least as well as the animal-derived surfactants Survanta and Curosurf. The ideal surfactant comparison trial to demonstrate which surfactant is better has yet to be conducted. Future surfactant comparison trials should pay particular attention to study design, be appropriately sized, and include long-term follow-up.

Links

  • Publisher Full Text
  • Publisher Full Text
  • Authors

    Moya F, Maturana A

    Institution

    Department of Neonatology, New Hanover Regional Medical Center and Coastal Area Health Education Center, 2131 South 17th Street, Suite 405, Wilmington, NC 28402, USA. fernando.moya@coastalahec.org

    Source

    Clinics in perinatology 34:1 2007 Mar pg 145-77, viii

    MeSH

    Animals
    Humans
    Infant, Newborn
    Infant, Premature
    Pulmonary Surfactants
    Respiratory Distress Syndrome, Newborn

    Pub Type(s)

    Comparative Study
    Journal Article
    Review

    Language

    eng

    PubMed ID

    17394936