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Comparative efficacy of pulmonary surfactant in respiratory distress syndrome in preterm infants: a Bayesian network
Caihong Qiu1, Cui Ma1, Nana Fan1
1Maternity and Child Health Care of Zaozhuang, China.
Insights
Surfactant A significantly reduces mortality in preterm infants with respiratory distress syndrome compared to beractant. Other surfactants also show improved efficacy, with Surfactant A being the most effective option.
Area of Science:
- Neonatal Medicine
- Pulmonology
- Pharmacology
Background:
- Respiratory distress syndrome (RDS) is a common and serious condition in preterm infants.
- Pulmonary surfactant therapy is a cornerstone in managing RDS, but comparative efficacy of different surfactant preparations is not well-established.
Purpose of the Study:
- To compare the efficacy of six different pulmonary surfactant preparations in treating RDS in preterm infants.
- To provide an evidence-based reference for selecting the optimal surfactant for clinical practice.
Main Methods:
- A systematic literature search was conducted across major databases (MEDLINE, Embase, Cochrane Library, Clinical Trials) up to January 2019.
- Network meta-analysis was performed using R and RevMan 5.3 software to analyze relative risks and ranking probabilities.
- Six surfactant types were evaluated: beractant, surfactant A, calfactant, poractant, lucinactant, and colfosceril.
Main Results:
- All analyzed surfactants, except beractant, demonstrated significantly reduced mortality rates for RDS in preterm infants.
- Surfactant A showed the highest Surface Under the Cumulative Ranking (SUCRA) value (93.8%), indicating superior efficacy.
- Other surfactants had varying degrees of efficacy, with poractant (65.4%) and lucinactant (59.8%) ranking higher than calfactant (40.3%) and colfosceril (31.6%).
Conclusions:
- Pulmonary surfactant preparations other than beractant are more effective in reducing RDS mortality in preterm neonates.
- Surfactant A emerges as the most effective option for improving survival rates in preterm infants with respiratory distress syndrome.
Introduction:
The comparative efficacy of pulmonary surfactant in the treatment of respiratory distress syndrome in preterm infants remains unclear. We aimed to evaluate the effectiveness of different pulmonary surfactant in the treatment of respiratory distress syndrome in preterm infants and to provide an evidence-based reference for clinical use.
Material And Methods:
MEDLINE, Embase, The Cochrane Library, and Clinical Trials databases were electronically searched from inception to January 2019. Two reviewers independently screened literature and extracted data, and then R and RevMan 5.3 software packages were used to perform network meta-analysis.
Results:
The relative risk of respiratory distress syndrome in preterm infants associated with six different pulmonary surfactant was analysed, including beractant (Survanta), surfactant A (Alveofact), calfactant (Infasurf), poractant (Curosurf), lucinactant (Surfaxin), and colfosceril (Exosurf). Patients with the following drugs appeared to have significantly reduced mortality of respiratory distress syndrome compare with beractant: surfactant A (OR = 0.53, 95% CI: 0.31-0.90), calfactant (OR = 0.91, 95% CI: 0.85-0.97), poractant (OR = 0.72, 95% CI: 0.67-0.77), lucinactant (OR = 0.80, 95% CI: 0.71-0.90), and colfosceril (OR = 0.93, 95% CI: 0.87-0.99). The SUCRA (surface under the cumulative ranking) values for each of the drugs were: beractant (8.9%), surfactant A (93.8%), calfactant (40.3%), poractant (65.4%), lucinactant (59.8%), and colfosceril (31.6%).
Conclusions:
Compared with beractant, other pulmonary surfactants are more effective to reduce the mortality of respiratory distress syndrome in preterm infants. Surfactant A drugs appeared to have the best efficacy in reducing mortality of respiratory distress syndrome in preterm infants.
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