Limitations
As far as limitations of our study, apart from being a retrospective
study from across 6 centres, an important limitation of our study is
that we have not collected the data on pulmonary haemorrhage and its
association with the type of surfactant used. Study by Tridente et.al.
favours use of porcine surfactant which had noted lesser lung
haemorrhage whereas the cochrane review showed no
difference.4,7 We felt lung haemorrhage having
multiple etiologies in very small newborns including hemodynamically
significant PDA, sepsis, DIC has more confounding factors and
attributing it to type of surfactant type may not be easy in a
retrospective design. Possibility of approximation of dose of surfactant
due to more common whole-vial based dosing in place of exact
weight-based dosing remains inherent limitation of retrospective
study.13
Cost benefit analysis comparing the surfactant preparations has not been
attempted owing to the varied hospital policies of billing. This
precludes our assumption that bovine surfactant use may reduce the cost
compared to porcine surfactants. Magni et.al. have noted that here were
no significant differences in neonatal intensive care unit (NICU) length
of stay or NICU total costs between infants treated with beractant
(Survanta®), calfactant (Infasurf®) or poractant alfa (Curosurf®) in a
study data from developed countries and funded by Chiesi Farmaceutici
S.p.A.14
More data from a larger sample size, randomised controlled studies, from
India may be needed to address the issues of type of surfactant usage in
RDS with different morbidities and mortality.