Ali Ulaş TUĞCU, Deniz Anuk İNCE, Özden TURAN, Ayşe ECEVİT

Comparison of two surfactant preparates derived from the same animal for the treatment of respiratory distress syndrome

Aim: Respiratory distress syndrome (RDS) is a lung failure that starts after birth. Because of deficiency of surfactants in alveoli, thisbecomes one of the most important causes of morbidity and mortality in preterm neonates. In this study, we tried to compare theoutcomes of two types of natural surfactant, derived from same animal and aimed to manage the anxiety of clinicians while they arechoosing the most appropriate preparate for RDS treatment.Material and Methods: Newborns hospitalized in Baskent University Ankara Hospital Neonatal Intensive Care Unit between January2017 and August 2018 and administrated with calfactant and beractant for RDS treatment were retrospectively examined.Results: A total of 57 neonates were enrolled into the study. It was indicated that 38 (66.7%) of neonates were administered beractantand 19 (33.3%) were administered calfactant. We did not find any significant difference between beractant and calfactant groups,according to their genders, gestational weeks, their intubation situations, the duration of the oxygen requirement, antibiotic usagesand the durations of mechanical ventilation. It was determined that calfactant-administered neonates needed statistically morerepeat dose, than those in the beractant group (p= 0.029).Conclusions: We examined two natural surfactant preparates derived from same animal. Calfactant which has some conflictingreports was newly introduced to our unit for RDS treatment. This study aimed to identify the most appropriate treatment modality forRDS. It would be more instructive to plan larger and more creative studies to examine possible differences among natural surfactantpreparates.

PDF

___

1. Fanaroff AA, Martin RJ. The respiratory distress syndrome. In: Fanaroff AA, Martin RJ, (eds). Diseases of the fetus and infant. 9th edition. St. Louis: Missouri, Mosby year book, 2011:1075-92.
2. Qiu RX, Liu X, Wang JL, et al. Clinical effect of exogenous pulmonary surfactant in the treatment of severe neonatal infectious pneumonia: a multicenter prospective clinical trial. Zhongguo Dang Dai Er Ke Za Zhi 2019;21:327-31.
3. Orloff KE, Turner DA, Rehder KJ. The Current State of Pediatric Acute Respiratory Distress Syndrome. Pediatr Allergy Immunol Pulmonol 2019;32:35-44.
4. Polin RA, Carlo WA. Surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics 2014;133:156-63.
5. Figueras-Aloy J, Quero J, Carbonell-Estrany X, et al. Early administration of the second dose of surfactant (beractant) in the treatment of severe hyaline membrane disease. Acta Paediatr 2001;90:296-301.
6. Jeon GW, Oh M, Sin JB. Efficacy of Surfactant-TA, Calfactant and Poractant Alfa for Preterm Infants with Respiratory Distress Syndrome: A Retrospective Study. Yonsei Med J 2015;56:433-9.
7. Singh N, Halliday HL, Stevens TP, et al. Comparison of animal-derived surfactants for the prevention and treatment of respiratory distress syndrome in preterm infants. Cochrane Database Syst Rev 2015;12:CD010249.
8. Ramanathan R, Rasmussen MR, Gerstmann DR, et al. A randomized, multicenter masked comparison trial of poractant alfa (Curosurf) versus beractant (Survanta) in the treatment of respiratory distress syndrome in preterm infants. J Perinatol 2004;21:109-19.
9. Hall SB, Venkitaraman AR, Whitsett JA, et al. Importance of hydrophobic apoproteins as constituents of clinical exogenous surfactants. Am Rev Respir Dis 1992;145:24-30.
10. Ishisaka DY. Exogenous surfactant use in neonates. Ann Pharmacother. 1996:30:389-98.
11. Trembath A, Hornik CP, Clark R, et al. Comparative effectiveness of surfactant preparations in premature infants. J Pediatr 2013;163:955-60.
12. Gregory KE, Deforge CE, Natale KM, et al. Necrotizing enterocolitis in the premature infant: neonatal nursing assessment, disease pathogenesis, and clinical presentation. Adv Neonatal Care 2011;11:155-64.
13. Ballabh P. Intraventricular hemorrhage in premature infants: mechanism of disease. Pediatr Res 2010;67:1-8. 14. Jefferies A. Retinopathy of prematurity: Recommendations for screening. Paediatr Child Health 2010;15:667-74.
15. Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrom 2016 update. Neonatology 2017;111:107-25
16. Ramanathan R. Animal-derived surfactants: where are we? The evidence from randomized, controlled clinical trials. J Perinatol 2009;29:38-43.
17. Zayek MM, Eyal FG, Smith RC. Comparison of the Pharmacoeconomics of Calfactant and Poractant Alfa in Surfactant Replacement therapy. J Pediatr Pharmacol Ther 2018;23:146-51.
18. Bloom BT, Kattwinkel J, Hall RT, et al. Comparison of Infasurf (calf lung surfactant extract) to Survanta (Beractant) in the treatment and prevention of respiratory distress syndrome. Pediatrics 1997;100:31-8.
19. Bloom BT, Clark RH. Comparison of Infasurf (calfactant) and Survanta (beractant) in the prevention and treatment of respiratory distress syndrome. Pediatrics 2005;116:392-9.
20. Hastings LK, Renfro WH, Sharma R. Comparison of beractant and calfactant in a neonatal intensive care unit. Am J Health Syst Pharm 2004;61:257-60.
21. Dilli D, Çakmakçı E, Akduman H, et al. Comparison of three natural surfactants according to lung ultrasonography scores in newborns with respiratory distress syndrome. J Matern Fetal Neonatal Med 2019;24:1-7.