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Natural Versus Synthetic Surfactant Therapy in Respiratory Distress Syndrome of Prematurity

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Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objectives

To compare the clinical efficacy and the cost of treatment between the newborns who received either a natural or a protein-free synthetic surfactant for respiratory distress syndrome (RDS) of prematurity.

Methods

This is a retrospective analytical study incorporating comparisons of clinical parameters and cost in newborns having RDS of prematurity who received either Survanta (bovine lung extract), a natural surfactant or Surfact (protein-free colfosceril palmitate), a synthetic surfactant.

Results

There were 100 newborns who received either of the natural (n = 52) or synthetic (n = 48) surfactant with mean (SD) gestational age and mean (SD) birth weight of 31.5 (2.6) wk, 1425 (461) g and 32.2 (2.2) wk, 1519 (413) g, respectively. Majority of the newborns (> 90%) received endotracheal surfactant within the first 24 h of life and had similar baseline characteristics in either group. No differences were noted in ventilator settings on admission and 24 h after surfactant/admission. Oxygen requirement, extubation age, complications, hospital stay, and mortality were similar across groups, except that the necrotizing enterocolitis was noted only in natural surfactant group. There was a significant pharmacy cost savings in synthetic surfactant group.

Conclusion

Synthetic surfactant was comparable to natural surfactant with regard to outcomes, like ventilator settings, hospital stay, and mortality. Pharmacy cost was less in synthetic surfactant group.

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Data Availability

Deidentified individual participant data will be made available. The data will be made available upon publication to researchers who provide a methodologically sound proposal for use in achieving the goals of the approved proposal. Proposals should be submitted to dipen_patel258@yahoo.co.in.

References

  1. Soll RF. Synthetic surfactant for respiratory distress syndrome in preterm infants. Cochrane Database Syst Rev. 2000;1998:CD001149.

  2. Seger N, Soll R. Animal derived surfactant extract for treatment of respiratory distress syndrome. Cochrane Database Syst Rev. 2009. https://doi.org/10.1002/14651858.CD007836.

    Article  PubMed  Google Scholar 

  3. Bahadue FL, Soll R. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev. 2012;11:CD001456.

  4. Soll R, Ozek E. Multiple versus single doses of exogenous surfactant for the prevention or treatment of neonatal respiratory distress syndrome. Cochrane Database Syst Rev. 2009. https://doi.org/10.1002/14651858.CD000141.

    Article  PubMed  Google Scholar 

  5. Hubbard RM, Choudhury KM, Lim G. Treatment patterns and clinical outcomes in neonates diagnosed with respiratory distress syndrome in a low-income country: a report from Bangladesh. Anesth Analg. 2018;126:1684–6.

    Google Scholar 

  6. Vidyasagar D, Velaphi S, Bhat VB. Surfactant replacement therapy in developing countries. Neonatology. 2011;99:355–66.

    Article  CAS  Google Scholar 

  7. Papageorgiou C, Savvides A, Zachariadis M. International medical technology diffusion. J Int Econ. 2007;72:409–27.

    Article  Google Scholar 

  8. Sardesai S, Biniwale M, Wertheimer F, Garingo A, Ramanathan R. Evolution of surfactant therapy for respiratory distress syndrome: past, present, and future. Pediatr Res. 2017;81:240–8.

    Article  Google Scholar 

  9. Soll RF, Blanco F. Natural surfactant extract versus synthetic surfactant for neonatal respiratory distress syndrome. Cochrane Database Syst Rev. 2001. https://doi.org/10.1002/14651858.CD000144. Update. In: Cochrane Database Syst Rev. 2015;5:CD000144.

  10. Ardell S, Pfister RH, Soll R. Animal derived surfactant extract versus protein free synthetic surfactant for the prevention and treatment of respiratory distress syndrome. Cochrane Database Syst Rev. 2015. https://doi.org/10.1002/14651858.CD000144. Update. In: Cochrane Database Syst Rev. 2015;8:CD000144

  11. Kattwinkel J. Synthetic surfactants: the search goes on. Pediatrics. 2005;115:1075–6.

    Article  Google Scholar 

  12. Sankar MJ, Gupta N, Jain K, Agarwal R, Paul VK. Efficacy and safety of surfactant replacement therapy for preterm neonates with respiratory distress syndrome in low-and middle-income countries: a systematic review. J Perinatol. 2016;36 Suppl1:S36–48.

  13. Dechant KL, Faulds D. Colfosceril palmitate. A review of the therapeutic efficacy and clinical tolerability of a synthetic surfactant preparation (Exosurf Neonatal) in neonatal respiratory distress syndrome. Drugs. 1991;42:877–94.

  14. Bose C, Corbet A, Bose G, et al. Improved outcome at 28 days of age for very low birth weight infants treated with a single dose of a synthetic surfactant. J Pediatr. 1990;117:947–53.

    Article  CAS  Google Scholar 

  15. Corbet A, Bucciarelli R, Goldman S, Mammel M, Wold D, Long W. Decreased mortality rate among small premature infants treated at birth with a single dose of synthetic surfactant: a multicenter controlled trial. American Exosurf Pediatric Study Group 1. J Pediatr. 1991;118:277–84.

  16. World Health Organization. WHO model list of essential medicines, 20th list. March 2017, amended August 2017. Available at: https://apps.who.int/iris/bitstream/handle/10665/273826/EML-20-eng.pdf. Accessed on 18 Mar 2022.

  17. Jobe AH, Ikegami M. Biology of surfactant. Clin Perinatol. 2001;28:655– 69.

  18. Veldhuizen EJ, Diemel RV, Putz G, van Golde LM, Batenburg JJ, Haagsman HP. Effect of the hydrophobic surfactant proteins on the surface activity of spread films in the captive bubble surfactometer. Chem Phys Lipids. 2001;110:47–55.

    Article  CAS  Google Scholar 

  19. Nogee LM, de Mello DE, Dehner LP, Colten HR. Brief report: deficiency of pulmonary surfactant protein B in congenital alveolar proteinosis. N Engl J Med. 1993;328:406–10.

    Article  CAS  Google Scholar 

  20. Cole FS, Hamvas A, Nogee LM. Genetic disorders of neonatal respiratory function. Pediatr Res. 2001;50:157–62.

    Article  CAS  Google Scholar 

  21. Clark JC, Wert SE, Bachurski CJ, 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;92:7794–8.

    Article  CAS  Google Scholar 

  22. Kukkonen AK, Virtanen M, Järvenpää AL, Pokela ML, Ikonen S, Fellman V. Randomized trial comparing natural and synthetic surfactant: increased infection rate after natural surfactant? Acta Paediatr. 2000;89:556–61.

    Article  CAS  Google Scholar 

  23. Sweet DG, Turner MA, Straňák Z, et al. A first-in-human clinical study of a new SP-B and SP-C enriched synthetic surfactant (CHF5633) in preterm babies with respiratory distress syndrome. Arch Dis Child Fetal Neonatal Ed. 2017;102:F497-503.

    Article  Google Scholar 

  24. Ramanathan R, Biniwale M, Sekar K, et al. Synthetic surfactant CHF5633 compared with poractantalfa in the treatment of neonatal respiratory distress syndrome: amulticenter, double-blind, randomized, controlled clinical trial. J Pediatr. 2020;225:90–6.

    Article  CAS  Google Scholar 

  25. Flores-Nava G, López-Padilla M, Barrera-Millán E, Escobedo-Chávez E, Thompson-Chagoyan O, Humberto JR. Ensayoclínico con un surfactante artificial para el tratamiento del síndrome de dificultad respiratoria neonatal. Perinatol Reprod Hum. 1995;9:149–55.

    Google Scholar 

  26. Duman N, Tüzün F, Sever AH, et al. Nasal intermittent positive pressure ventilation with or without very early surfactant therapy for the primary treatment of respiratory distress syndrome. J Matern Fetal Neonatal Med. 2016;29:252–7.

    Article  CAS  Google Scholar 

  27. Bryson HM, Whittington R. Colfosceril palmitate. A pharmacoeconomic evaluation of a synthetic surfactant preparation (Exosurf Neonatal) in infants with respiratory distress syndrome. Pharmacoeconomics. 1994;6:563–77.

  28. Backhouse ME, Mauskopf JA, Jones D, et al. Economic outcomes of colfosceril palmitate rescue therapy in infants weighing 1250g or more with respiratory distress syndrome: results from a randomised trial. Pharmacoeconomics. 1994;6:358–69.

    Article  CAS  Google Scholar 

  29. Singh N, Hawley KL, Viswanathan K. Efficacy of porcine versus bovine surfactants for preterm newborns with respiratory distress syndrome: systematic review and meta-analysis. Pediatrics. 2011;128:e1588–95.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neonatology, Pramukhswami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, 388325, India

    Dipen V. Patel, Satvik C. Bansal & Somashekhar M. Nimbalkar

  2. Department of Pediatrics, Pramukhswami Medical College, Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India

    Mili Shah & Chintan L. Patel

  3. Central Research Services, Charutar Arogya Mandal, Karamsad, Gujarat, India

    Karamchand Patil & Somashekhar M. Nimbalkar

Authors
  1. Dipen V. Patel
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  2. Satvik C. Bansal
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  3. Mili Shah
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  4. Chintan L. Patel
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  5. Karamchand Patil
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  6. Somashekhar M. Nimbalkar
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Contributions

DVP, SCB, MS conceptualized and designed the study, coordinated and supervised data collection, carried out the final analysis, drafted the initial manuscript, and reviewed and revised the manuscript; CLP, KP designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript for important intellectual content; SMN conceptualized as well as designed the study and revisited the manuscript for important intellectual content; All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved. DVP will act as the guarantor for this paper.

Corresponding author

Correspondence to Dipen V. Patel.

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Ethical Approval

The study was approved by the Institutional Ethics Committee of H M Patel Center for Medical Care and Education, Karamsad, Gujarat.

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Patel, D.V., Bansal, S.C., Shah, M. et al. Natural Versus Synthetic Surfactant Therapy in Respiratory Distress Syndrome of Prematurity. Indian J Pediatr 89, 1086–1092 (2022). https://doi.org/10.1007/s12098-022-04166-4

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