Abstract
BACKGROUND & OBJECTIVES: Porcine surfactant (200 mg/kg initial
dose) seems to be superior over bovine surfactants (100 mg/kg) in
respiratory distress syndrome (RDS). There is limited data on choice of
surfactant from the developing world. Logically using higher doses of
porcine surfactant comes with additional burden of cost. We decided to
evaluate the clinical effect of different types of surfactants.
METHODS: A retrospective analysis was conducted from August
2019 to December 2022 in 6 tertiary centres. Neonates 24-34 weeks of
gestation with RDS requiring either porcine (200 mg/kg) or bovine
surfactant (100 mg/kg) were enrolled. The proportion of combined
outcomes of death and or CLD, redosing and other morbidities in either
group were analysed. The subgroup of preterm >28 weeks and
outcomes between different surfactants were analysed.
RESULTS: Out of 1149 eligible babies, 302 (26%) received
surfactant after stabilisation with CPAP. 158 received porcine and 144
received bovine surfactant via INSURE technique. There was a higher
combined outcome of death or CLD in porcine compared to the bovine group
[48 (30%) vs 20 (13%), OR:2.7; 95% CI:1.5-4.8; p=0.001] and
similar combined outcomes in >28 weeks sub-group. Redosing
[27 (17%) Vs 18 (12%), OR:1.4; 95% CI:0.7-2.7; p=0.2] was
similar. Other morbidities like air leak, invasive ventilation, CPAP
duration were similar between both the groups and different types of
surfactants.
CONCLUSION: Porcine surfactant at 200mg/kg had similar combined
outcomes of death/ CLD and redosing compared to bovine surfactant in
preterm >28 weeks. Considering the cost burden in the
developing world, the efficacy needs evaluation in randomised clinical
trials.