Comparison of the Efficacy of Three Natural Surfactants (Curosurf, Survanta, and Alveofact) in the Treatment of Respiratory Distress Syndrome Among Neonates: A Randomized Controlled Trial|
Mussavi, Mirhadi; Mirnia, Keyvan & Asadollahi, Khairollah
Background: Although several different types of natural surfactants are available, including Alveofact, Curosurf, and Survanta, the preferred type
and the magnitude of their effects are unknown.
Objectives: This study was designed to compare the effects of these three surfactants on the gas exchange and clinical outcomes of neonates with
respiratory distress syndrome (RDS).
Methods: This triple-blind randomized clinical trial studied all preterm neonates37 weeks with RDS who were admitted to the neonatal intensive
care unit (NICU) of Taleghani hospital (Tabriz, Iran) between 2012 and 2013. The patients were divided into three groups, each of which received one
of these surfactants. The incidences of ventilator dependency, patent ductus arteriosus (PDA), broncho-pulmonary dysplasia (BPD), retinopathy of
prematurity (ROP), intraventricular hemorrhage (IVH), hospital-stay length, and continuous positive airway pressure (CPAP) failure, as well as blood
gas levels, were recorded as endpoint measurements and compared.
Results: In total, 165 neonates of gestational age ≤ 37 weeks with RDS were examined. Neonates were allocated to three different groups randomly,
including a Survanta group (n = 49), a Curosurf group (n = 62), and an Alveofact group (n = 54). The mean gestational age of the neonates was 31.6 ±
3.7 weeks, and their mean weight was 1,840 ± 790 grams. The male/female ratio was 2:1 (67% male, 33% female); 104 (63%) neonates were ≤ 32 weeks
gestational age, and 61 (37%) were > 32 weeks. There were no significant differences for gender or demographic characteristics among the neonates
in relation to the type of applied surfactant. According to the clinical parameters (BPD, IVH, ROP, hospital-stay length, and mechanical ventilation
requirement), no significant differences were observed between the groups before and after surfactant administration, but the differences between
the Survanta and Alveofact groups for the incidence rates of pneumothorax (P = 0.03) and pulmonary hemorrhage (P = 0.03) were statistically significant.
Conclusions: Nosignificant differences were observed inmostof the clinical variables between the three types of natural surfactant, but in neonates
≤ 32 weeks, the incidence of pneumothorax was significantly higher in the Alveofact group; in neonates > 32 weeks, the incidences of PDA, mean
hospital-stay length, and mean mechanical ventilation time were also significantly higher in the same group. It thus appears that Curosurf and
Survanta replacement therapies among premature neonates with RDS perform better than Alveofact replacement therapy.
Neonates; Pulmonary Surfactant; Iran