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Is there really a clinical difference in surfactant preparations?

Journal of Perinatology volume 30, page 698 (2010)Cite this article

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Dr Lutchman poses the question, ‘Have we been down this road before?’ Is there really a clinical difference in surfactant preparations? The debate of which surfactant to use in the management of very premature infants with respiratory distress syndrome has been ongoing for two decades. In the United States, the debate began with the Food and Drug Administration's approval of the first synthetic surfactant, Exosurf (colfosceril palmitate), closely followed by approval of the animal-derived surfactant, Survanta (beractant). The debate continued with the subsequent approval of more rapidly acting animal-derived surfactants, Infasurf (calfactant) and Curosurf (poractant), with higher concentrations of surfactant phospholipids and surfactant proteins. With preferential purchasing, clinical neonatologists showed their interest in surfactants with a faster onset of action and smaller volume of administration. Slower acting synthetic surfactant, Exosurf, is no longer marketed in the United States. Our recent studies of very premature, mechanically ventilated infants with respiratory distress syndrome1, 2 continue to incrementally evaluate differences in available surfactant preparations. Although we have not shown a difference in mortality with our small sample size, it is clear that poractant alfa has a more rapid onset of action compared with beractant.3 Poractant alfa, with a larger initial dose (200 mg kg–1) compared with beractant (100 mg kg–1), made possible by a higher concentration of phospholipid in poractant alfa, is associated with a longer dose-related half-life, giving poractant alfa an additional longer duration of action.4 Smaller volumes of administration may also reduce the hypercarbia and acute increase in cerebral blood flow, in these very fragile infants.5 The increased clinical efficacy of multiple doses of poractant alfa (200 mg kg–1 initial dose) was documented in a large European trial.6 In addition, our preliminary data suggest that improved pulmonary function in the poractant-treated very premature infants with respiratory distress syndrome may reduce the number with clinically significant patent ductus arteriosus.2

We agree with Dr Lutchman that the surfactant story is far from complete and that ideally a comprehensive series of definitive, randomized control trials of available surfactants, with appropriate power for subgroup analysis, be funded and conducted to assess relative efficacy of surfactant preparations and dosing on preterm infant morbidity and mortality.7 Unfortunately, these studies are challenging to design, expensive to conduct and the question of how to fund them persists.

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References

  1. Fujii AM, Patel SM, Allen R, Doros G, Guo CY, Testa S . Poractant alfa and beractant treatment of very premature infants with respiratory distress syndrome. J Perinatol advance online publication 25 March 2010; doi: 10.1038/jp.2010.20.

  2. Fujii A, Allen R, Doros G, O’Brien S . Patent ductus arteriosus hemodynamics in very premature infants treated with poractant alfa or beractant for respiratory distress syndrome. J Perinatol advance online publication 25 March 2010; doi: 10.1038/jp.2010.21.

  3. Holm B, Cummings JJ . Is there evidence for a mortality difference between exogenous surfactant preparations in neonatal RDS? J Appl Res 2008; 8 (2): 78–83.

    CAS  Google Scholar 

  4. Cogo PE, Facco M, Simonato M, Verlato G, Rondina C, Baritussio A et al. Dosing of porcine surfactant: effect on kinetics and gas exchange in respiratory distress syndrome. Pediatrics 2009; 124 (5): e950–e957. Epub 2009.

    Article  PubMed  Google Scholar 

  5. Fujii AM, Bailey J, Doros G, Sampat K, Sikes NC, Mason M et al. Cerebral blood flow responses to beractant and poractant administration. J Neonatal-Perinatal Medicine 2009; 2: 27–34.

    Google Scholar 

  6. Speer CP, Robertson B, Curstedt T, Halliday HL, Compagnone D, Geffeller O et al. Randomized European multicenter trial of surfactant replacement therapy for severe neonatal respiratory distress syndrome: single versus multiple doses of Curosurf. Pediatrics 1992; 89: 13–20.

    CAS  PubMed  Google Scholar 

  7. Fujii AM, Carillo M . Animal-derived surfactant treatment of respiratory distress syndrome in premature neonates: a review. Drugs Today 2009; 45 (9): 697–709.

    Article  CAS  Google Scholar 

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  1. Department of Pediatrics, Boston Medical Center, One Boston Medical Center Place, Boston, MA, USA

    Alan Fujii

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Correspondence to Alan Fujii.

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Competing interests

Dr Fujii was supported by an unrestricted research grant from Dey LP, Napa, CA and Chiesi Farmaceutici Spa, Pharma, Italy.

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Fujii, A. Is there really a clinical difference in surfactant preparations?. J Perinatol 30, 698 (2010). https://doi.org/10.1038/jp.2010.90

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