Pediatric Drugs

, Volume 4, Issue 8, pp 485–492 | Cite as

Lung Surfactants for Neonatal Respiratory Distress Syndrome

Animal-Derived or Synthetic Agents?
  • Gautham K. Suresh
  • Roger F. Soll
Current Opinion

Abstract

Exogenous surfactant therapy is widely used in the management of neonatal respiratory distress syndrome. Two types of surfactants are available: synthetic surfactants, and those derived from animal sources (‘natural’ surfactants). Both of these surfactants have been shown to be effective. In this article, we review the evidence to compare the two types of surfactants in terms of their physical properties, physiologic effects, and clinical outcomes.

Natural surfactants have been shown to have advantages over synthetic surfactants in their physical properties and physiologic effects in animals, as well as in humans. A systematic review of 11 randomized clinical trials comparing natural and synthetic surfactants demonstrated that the use of natural surfactant preparations results in greater clinical benefits compared with synthetic surfactants. These benefits include a more rapid improvement in oxygenation and lung compliance after surfactant therapy, a decrease in the risk of mortality (typical relative risk 0.87; typical risk difference −0.02), and a decrease in the risk of pneumothorax (typical relative risk 0.63; typical risk difference −0.04). Although the use of natural surfactants results in a slightly increased risk of intraventricular hemorrhage (typical relative risk 1.09; typical risk difference 0.03), there is no increase in the risk of grade 3 or 4 intraventricular hemorrhage.

There are theoretical but unproven risks of natural surfactants, such as transmission of infectious agents, immunogenicity and impurities in composition. The use of natural surfactants is preferred in most situations. In addition, clinicians should determine the costs of different types of surfactants in their individual practice settings and use this information in decision-making.

Keywords

DPPC Patent Ductus Arteriosus Intraventricular Hemorrhage Surfactant Protein Synthetic Surfactant 

Notes

Acknowledgements

Dr Soll has acted as a paid consultant and invited speaker for several of the pharmaceutical companies that manufacture surfactant preparations (Abbott Laboratories, Ross Laboratories, Chiesi Pharmaceuticals, Dey Laboratories, Burroughs Wellcome). He is the principal investigator or co-principal investigator of two of the randomized controlled trials cited in this review.

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Copyright information

© Adis International Limited 2002

Authors and Affiliations

  • Gautham K. Suresh
    • 1
  • Roger F. Soll
    • 1
  1. 1.Department of PediatricsUniversity of Vermont College of MedicineBurlingtonUSA

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