Comparative efficacy and safety of late surfactant preparations: a retrospective study

Lane, Morgan D.; Kishnani, Sujata; Udemadu, Obianuju; Danquah, Samuel Eshun; Treadway, Robert M.; Langman, Aaliyah; Balevic, Stephen J.; Jackson, Wesley M.; Laughon, Matthew M.; Hornik, Christoph P.; Greenberg, Rachel G.; Clark, Reese H.; Zimmerman, Kanecia O.

doi:10.1038/s41372-021-01142-2

Cited by 4 publications

(2 citation statements)

References 29 publications

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“…Previous systematic evaluations of randomized controlled trials and real-world evidence have shown comparable outcomes for beractant and other commonly used animal-derived surfactants [4,[32][33][34], although these studies did not examine outcomes by the method of administration (e.g., LISA vs INSURE or standard of care). A recent systematic review and meta-analysis of randomized controlled trials (RCTs), published in 2020, demonstrated beractant and poractant alfa treatment as having comparable rates of death, BPD, pneumothorax, and air leak syndrome [4].…”

Section: Review Beractant Treatment For Rdsmentioning

confidence: 99%

Less Invasive Surfactant Administration: A Review of Current Evidence of Clinical Outcomes With Beractant

Luna¹,

Unnebrink²,

Martinez-Tristani³

et al. 2022

Cureus

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Evidence supporting clinical recommendations or approval for less invasive surfactant administration (LISA) has primarily examined heterogeneous or small-volume (e.g., 1.25-2.5 mL/kg) animal-derived surfactant regimens. To address the evidence gap for larger-volume (e.g., 4-5 mL/kg) animal-derived surfactants, the aim of this review was to evaluate and summarize LISA literature for widely used larger-volume beractant. Surfactant treatment and the LISA technique were initially summarized. The available literature on beractant with LISA was thoroughly assessed and reviewed, including a recent systematic analysis, studies from regions where access or preferences may influence reliance on larger-volume surfactants, and investigations of short-and long-term outcomes. The available literature indicated improved short-term outcomes, including less need for mechanical ventilation, death, or bronchopulmonary dysplasia, and no negative long-term developmental outcomes when beractant was administered via LISA compared with older, more invasive techniques. The rates of short-term outcomes were similar to those previously observed in examinations of LISA with small-volume surfactants, including in populations reflecting very preterm infants. As uptake of LISA is expected to increase, future research directions for larger-volume surfactants include cost-effectiveness evaluations and robust examinations of repeat dosing and surfactant reflux to further inform clinical practice. This review provides a detailed assessment of the literature describing surfactant and LISA, with a focus on studies of beractant. Collectively, the available evidence supports the use of beractant with LISA based both on short-term and long-term outcomes relative to more invasive techniques and comparability of outcomes with small-volume surfactants and may be valuable in guiding clinical decision-making.

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Section: Review Beractant Treatment For Rdsmentioning

confidence: 99%

Less Invasive Surfactant Administration: A Review of Current Evidence of Clinical Outcomes With Beractant

Luna¹,

Unnebrink²,

Martinez-Tristani³

et al. 2022

Cureus

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“…Surfactant dysfunction could play a role in ventilated preterm infants beyond the classic respiratory distress syndrome (RDS), with temporary improvement in pulmonary function seen after surfactant administration in preterm infants requiring prolonged mechanical ventilation 16 17. The use of late surfactant has been increasing over the last decades, with a recent multicentre study reporting that up to 1.4% of preterm infants received surfactant beyond 48–72 hours of age 18. However, the effects of this therapy on short and long-term neonatal outcomes in this population have not been systematically reviewed, and given the lack of effective treatments for evolving BPD in this population, this is a field that needs further investigation.…”

Section: Introductionmentioning

confidence: 99%

Late surfactant administration after 48 hours of age in preterm neonates with respiratory insufficiency: a systematic review and meta-analysis

Solís-García,

Elias,

Dunn

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo systematically review and meta-analyse the effect of late surfactant administration versus placebo in reducing the incidence of death or bronchopulmonary dysplasia (BPD) in preterm infants.DesignPubMed, EMBASE, CINAHL and Cochrane CENTRAL were searched until 30 May 2023, for randomised controlled trials (RCTs) comparing administration of surfactant after 48 hours of age versus placebo in preterm ventilator-dependent neonates. The primary outcome was incidence of death or BPD at 36 weeks’ postmenstrual age (PMA). Secondary outcomes included incidence of BPD at 36 weeks PMA, pre-discharge mortality, use of postnatal steroids, post-discharge respiratory support, treatment with steroids or hospitalisation prior to 1-year corrected age.ResultsPooled analyses of four RCTs (N=850) showed no statistically significant difference between groups in the incidence of death or BPD at 36 weeks’ PMA (relative risk (RR) 0.99; 95% CI 0.90 to 1.10; Grades of Recommendation, Assessment, Development and Evaluation (GRADE): moderate). Late surfactant administration significantly decreased the need for post-discharge respiratory support prior to 1-year corrected age (two RCTs; N=522; RR 0.72; 95% CI 0.59 to 0.89; GRADE: low). Other secondary outcomes did not differ significantly between the groups.ConclusionsAdministration of late surfactant does not improve the rates of death or BPD at 36 weeks when administered to preterm infants with prolonged respiratory insufficiency. Additional adequately powered trials are needed to establish the efficacy of late surfactant therapy in preterm infants.PROSPERO registration numberCRD42023432463.

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Use of surfactant beyond respiratory distress syndrome, what is the evidence?

Desai,

Yildiz Atar,

Lakshminrusimha

et al. 2024

J Perinatol

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Comparative efficacy and safety of late surfactant preparations: a retrospective study

Cited by 4 publications

References 29 publications

Less Invasive Surfactant Administration: A Review of Current Evidence of Clinical Outcomes With Beractant

Less Invasive Surfactant Administration: A Review of Current Evidence of Clinical Outcomes With Beractant

Late surfactant administration after 48 hours of age in preterm neonates with respiratory insufficiency: a systematic review and meta-analysis

Use of surfactant beyond respiratory distress syndrome, what is the evidence?

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