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In response to mortality in preterm infants with respiratory distress syndrome treated with poractant alfa, calfactant or beractant: a retrospective study

Journal of Perinatology volume 33, pages 165–166 (2013)Cite this article

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A large subset of the data presented in the article Mortality in preterm infants with respiratory distress syndrome treated with poractant alfa, calfactant or beractant: a retrospective study were published by the same authors in two abstracts in 2007.1, 2 The first abstract reported that the Curosurf population has a lower mortality rate than Infasurf or Survanta. The second abstract reported that the same Curosurf population had a shorter length of stay than either the Survanta or Infasurf population. From the initial placebo-controlled trials of lung surfactant replacement therapy, the mortality improvement due to surfactant therapy resulted in an increase, not a decrease, in the length of stay. Preventing death from Respiratory Distress Syndrome will of course produce a much longer length of stay than dying from Respiratory Distress Syndrome. One report showed the length of stay tripled, from 20–61 days for surfactant-treated infants compared with placebo.3 How, in this population, was it possible for Curosurf patients to have both a lower mortality and a shorter length of stay? The self-evident answer is that Curosurf was administered to more patients who had low mortality risk. Similar patients cared for by physicians who use Infasurf and Survanta are not included in the database, because they did not receive any surfactant therapy at all.

The article as published, omitted the length of stay data and reported only the mortality data. It does have multiple regression analyses ‘correcting’ for possible differences in risk among patients enrolled. Those techniques cannot correct for systematic differences in patient selection. The paper omits this data, which shows that the populations were different.

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References

  1. Bhatia J, Saunders WB, Friedlich PT, Levin PT, Sekar KC, York JM et al. Differences in mortality among infants treated with three different natural surfactants for respiratory distress syndrome. Pediatric Academic Societies Meeting. E-PAS2007:617935.16, 2007.

  2. Sekar KC, Bhatia J, Ernst FR, Saunders WB, Levin PT, Ramanathan R . Resource use in pre term neonates with respiratory distress syndrome (RDS) treated with one of three different natural surfactants: analyses using a large hospital data base. Acta Pediatr 2007; 96 (Suppl 456): p109 (Abstract).

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  3. Tubman TRJ, Halliday HL, Normand C . Cost of surfactant replacement therapy for severe neonatal respiratory distress syndrome: a randomised controlled trial. Brit Med J 1990; 301: 842–845.

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  4. Retractions: Guidance from the Committee on Publication Ethics. http://publicationethics.org/files/retraction%20guidelines.pdf.

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Authors and Affiliations

  1. Professor of Pediatrics and Physiology and Biophysics, State University of New York at Buffalo, Buffalo, NY, USA

    E A Egan

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  1. E A Egan
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Correspondence to E A Egan.

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Competing interests

I am Chief Medical Officer of ONY, Inc., manufacturer of Infasurf (calfactant).

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Egan, E. In response to mortality in preterm infants with respiratory distress syndrome treated with poractant alfa, calfactant or beractant: a retrospective study. J Perinatol 33, 165–166 (2013). https://doi.org/10.1038/jp.2012.163

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