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Comparative effectiveness of surfactant preparations in premature infants

Andrea Trembath1, Christoph P Hornik, Reese Clark

  • 1Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH.

The Journal of Pediatrics
|June 18, 2013
PubMed

Insights

Three surfactant preparations, beractant, calfactant, and poractant alfa, showed similar effectiveness in preventing air leak syndromes, death, and bronchopulmonary dysplasia or death in premature infants. Site variations may explain previously observed differences in mortality.

Area of Science:

  • Neonatology
  • Pulmonology
  • Pharmacology

Background:

  • Premature infants often require surfactant replacement therapy to manage respiratory distress syndrome.
  • Different surfactant preparations, including beractant, calfactant, and poractant alfa, are available, with varying clinical use and reported outcomes.
  • Comparative effectiveness data are crucial for guiding therapeutic choices in neonatal intensive care.

Purpose of the Study:

  • To compare the effectiveness of beractant, calfactant, and poractant alfa in premature infants.
  • To evaluate the prevention of air leak syndromes, death, and a composite of bronchopulmonary dysplasia (BPD) or death.
  • To identify potential differences in outcomes among these surfactant preparations.

Main Methods:

  • A comparative effectiveness study involving premature infants from 322 US neonatal intensive care units (2005-2010).
  • Treatment groups included beractant, calfactant, and poractant alfa.
  • Outcomes (air leak syndromes, death, BPD or death) were compared using adjusted analyses considering gestational age, antenatal steroids, discharge year, and small for gestational age status.

Main Results:

  • A total of 51,282 infants received surfactant: 40% beractant, 30% calfactant, 30% poractant alfa.
  • Adjusted analyses revealed similar risks for air leak syndromes across all three surfactant groups.
  • No significant differences were observed in the risk of death or the composite outcome of BPD or death among the surfactant preparations.

Conclusions:

  • Beractant, calfactant, and poractant alfa demonstrate comparable effectiveness in preventing key adverse outcomes in premature infants.
  • Observed differences in mortality between surfactants may be attributed to variations in clinical practice or site-specific factors rather than inherent effectiveness.
  • These findings support the use of any of these three surfactant preparations with similar expectations for preventing major respiratory complications.
Abstract

Keywords:
BPDBronchopulmonary dysplasiaGAGestational ageNICUNeonatal intensive care unitRDSRespiratory distress syndrome

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