Animal‐derived or synthetic surfactant for the treatment of neonatal respiratory distress syndrome: a review

Animal‐derived surfactants containing SP‐B and SP‐C are more effective in vitro and in animal models than their synthetic counterparts, but are not as effective as unmodified, naturally occurring surfactant. In clinical trials involving newborn babies with respiratory distress syndrome (RDS) these short‐term differences are reflected as improvements in gas exchange and lung function. Treatment with animal‐derived surfactants results in fewer air leaks and lower neonatal mortality. The evidence is now strong enough to recommend routine use of animal‐derived surfactants in very preterm infants with RDS. The newer generation of synthetic surfactants may be important in the future as they have the advantages of currently available animal products with the addition of better resistance to inactivation.

[1]  R. Soll,et al.  Natural surfactant extract versus synthetic surfactant for neonatal respiratory distress syndrome. , 2001, The Cochrane database of systematic reviews.

[2]  V. Fellman,et al.  Randomized trial comparing natural and synthetic surfactant: increased infection rate after natural surfactant? , 2000, Acta paediatrica.

[3]  H. Halliday,et al.  Randomized trial comparing natural and synthetic surfactant: increased infection rate after natural surfactant? , 2000, Acta paediatrica.

[4]  A. Vaandrager,et al.  Lung Surfactant Proteins A and D in Innate Immune Defense , 2000, Neonatology.

[5]  D. Milligan,et al.  Pumactant and poractant alfa for treatment of respiratory distress syndrome in neonates born at 25–29 weeks' gestation: a randomised trial , 2000, The Lancet.

[6]  A. Jobe,et al.  Positive end-expiratory pressure preserves surfactant function in preterm lambs. , 1999, American journal of respiratory and critical care medicine.

[7]  D. D. da Costa,et al.  Comparative trial of artificial and natural surfactants in the treatment of respiratory distress syndrome of prematurity: Experiences in a developing country , 1999, Pediatric pulmonology.

[8]  J. Goerke,et al.  Pulmonary surfactant: functions and molecular composition. , 1998, Biochimica et biophysica acta.

[9]  P. Germann,et al.  Comparison of rSP‐C surfactant with natural and synthetic surfactants after late treatment in a rat model of the acute respiratory distress syndrome , 1998, British journal of pharmacology.

[10]  S. Kempley,et al.  Randomized trial examining cerebral haemodynamics following artificial or animal surfactant , 1998, Acta paediatrica.

[11]  J. Aranda,et al.  Comparative efficacy of exosurf and survanta surfactants on early clinical course of respiratory distress syndrome and complications of prematurity. , 1997, Journal of perinatology : official journal of the California Perinatal Association.

[12]  R. Auten,et al.  A multicenter randomized masked comparison trial of synthetic surfactant versus calf lung surfactant extract in the prevention of neonatal respiratory distress syndrome. , 1997, Pediatrics.

[13]  J. Johansson,et al.  Molecular structures and interactions of pulmonary surfactant components. , 1997, European journal of biochemistry.

[14]  H. Haagsman,et al.  The Pulmonary Surfactant System: Biochemical and Clinical Aspects , 1997, Lung.

[15]  R. Miller,et al.  A multicenter randomized, masked comparison trial of natural versus synthetic surfactant for the treatment of respiratory distress syndrome. , 1996, The Journal of pediatrics.

[16]  T. Nemoto,et al.  Biophysical properties of protein‐free, totally synthetic pulmonary surfactants, ALEC and Exosurf, in comparison with surfactant TA , 1994, Acta paediatrica Japonica : Overseas edition.

[17]  J. Corcoran,et al.  Comparison of surface properties and physiological effects of a synthetic and a natural surfactant in preterm rabbits. , 1994, Archives of disease in childhood. Fetal and neonatal edition.

[18]  S. Hawgood,et al.  Lung function, surfactant apoprotein content, and level of PEEP in prematurely delivered rabbits. , 1994, Journal of applied physiology.

[19]  G. Parry,et al.  Static respiratory compliance in the newborn. III: Early changes after exogenous surfactant treatment. , 1994, Archives of disease in childhood. Fetal and neonatal edition.

[20]  L. Wright,et al.  A multicenter randomized trial comparing two surfactants for the treatment of neonatal respiratory distress syndrome , 1993 .

[21]  A. Jobe,et al.  Changes in exogenous surfactant in ventilated preterm lamb lungs. , 1993, The American review of respiratory disease.

[22]  W. Seeger,et al.  Surfactant inhibition by plasma proteins: differential sensitivity of various surfactant preparations. , 1993, The European respiratory journal.

[23]  A. Jobe,et al.  Treatment responses to surfactants containing natural surfactant proteins in preterm rabbits. , 1993, The American review of respiratory disease.

[24]  A. Jobe,et al.  Different ventilation strategies alter surfactant responses in preterm rabbits. , 1992, Journal of applied physiology.

[25]  J. Cummings,et al.  A controlled clinical comparison of four different surfactant preparations in surfactant-deficient preterm lambs. , 1992, The American review of respiratory disease.

[26]  A. Jobe,et al.  Effects of surfactant protein-A on surfactant function in preterm ventilated rabbits. , 1990, The American review of respiratory disease.

[27]  G. Heldt,et al.  The efficacy and safety of KL4-surfactant in preterm infants with respiratory distress syndrome. , 1996, American journal of respiratory and critical care medicine.

[28]  P. Lewallen,et al.  A multicenter, randomized trial comparing synthetic surfactant with modified bovine surfactant extract in the treatment of neonatal respiratory distress syndrome. Vermont-Oxford Neonatal Network. , 1996, Pediatrics.

[29]  H. Taeusch,et al.  Modified bovine surfactant (Survanta) versus a protein-free surfactant (Exosurf) in the treatment of respiratory distress syndrome in preterm infants: a pilot study. , 1994, Journal of the National Medical Association.