Pumactant and poractant alfa for treatment of respiratory distress syndrome in neonates born at 25–29 weeks' gestation: a randomised trial

@article{Ainsworth2000PumactantAP,
  title={Pumactant and poractant alfa for treatment of respiratory distress syndrome in neonates born at 25–29 weeks' gestation: a randomised trial},
  author={Sb Ainsworth and M W Beresford and D. W. A. Milligan and Nj Shaw and Jns Matthews and AC Fenton and M. W. Platt},
  journal={The Lancet},
  year={2000},
  volume={355},
  pages={1387-1392}
}
BACKGROUND Exogenous surfactant preparations vary in their constitution and biophysical properties. Synthetic and animal-derived preparations lower the rate of death compared with controls. No significant differences in mortality or important long-term clinical outcomes have been shown between them in randomised trials. We did a randomised controlled trial to compare pumactant, a synthetic surfactant, with poractant alfa, an animal-derived surfactant, both of which are widely used in the UK… 
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In this study, infants who received poractant had shorter duration of intubation than infants treated with beractant, without any difference in the duration of oxygen therapy or hospitalization.
Is there a Difference in Surfactant Treatment of Respiratory Distress Syndrome in Premature Neonates? A Review
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New surfactant administration strategies are described, complimenting new respiratory support strategies, designed to minimize invasive mechanical ventilation and decrease the frequency of chronic lung disease.
An observational study of surfactant treatment in infants of 23–30 weeks' gestation: comparison of prophylaxis and early rescue
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    The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
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TLDR
Comparison studies show that multiple doses may be needed if surfactant is used to treat established RDS but early or prophylactic treatment is superior for infants with gestational ages less than 30 weeks, and a meta-analysis of 5 comparative studies suggests that a dose of 200 mg/kg of poractant alfa is associated with lower mortality compared with 100 mg/ kg of beractant.
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TLDR
Poractant alfa may be more beneficial and associated with fewer complications than bovine lipid extract surfactant and larger studies are needed to determine whether observed possible benefits translate in shorter hospital admissions, or other long term benefits and determine whether there is a difference in mortality.
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  • S. Ainsworth, D. Milligan
  • Medicine
    American journal of respiratory medicine : drugs, devices, and other interventions
  • 2002
TLDR
Despite being an effective therapy for RDS, surfactant has failed to have a significant impact on the incidence of chronic lung disease in survivors and is considered a cost-effective therapy compared with other therapeutic interventions in premature infants.
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TLDR
Surviving infants who received lucinactant and other surfactants in the SELECT and STAR trials individually and from analysis using combined data from these 2 trials sought to determine and compare survival and pulmonary and neurodevelopmental outcomes through 1 year corrected age.
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TLDR
Evidence from randomized controlled trials indicates that treatment with natural surfactant results in faster weaning of supplemental oxygen and mean airway pressure, decreased duration of mechanical ventilation, and decreased mortality when compared to synthetic surfactants.
Does surfactant type cause a differential proinflammatory response in preterm infants with respiratory distress syndrome?
TLDR
The postnatal airway inflammatory response observed in preterm infants is not altered by the instillation of either surfactant preparation, and ventilation requirements and clinical outcomes were similar between the two groups.
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TLDR
A reasonable recommendation is to treat the infants as soon as clinical signs of developing respiratory distress appear with an individual dose for each infant, and it is found that early treatment with surfactant replacement- within 6 hours of birth- is more effective, and resulted in a significant reduction of mortality rate.
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