Comparison of animal-derived surfactants for the prevention and treatment of respiratory distress syndrome in preterm infants

Singh, Neetu; Halliday, Henry L.; Stevens, Timothy P.; Suresh, Gautham; Soll, Roger F.; Rojas-Reyes, María Ximena

doi:10.1002/14651858.cd010249.pub2

Cited by 84 publications

(72 citation statements)

References 55 publications

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“…Today many infants are maintained on non-invasive ventilation even when surfactant is required. Need for re-dosing can be minimised by using the larger dose of 200 mg/kg of poractant alfa [77]. Prediction of IN-SUR-E failure using clinical criteria and blood gases could define a population that would be reasonable to maintain on MV for a while after surfactant has been given [78, 79].…”

Section: Surfactant Therapymentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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Section: Surfactant Therapymentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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“…Comparisons among animal-derived surfactants have also shown differences in clinical effect. Overall there is a survival advantage when a 200 mg/kg dose of poractant alfa is compared with 100 mg/kg of beractant or 100 mg/kg poractant alfa to treat RDS but it is unclear whether this is a dose effect or related to differences in the surfactant preparations [58]. …”

Section: Surfactant Therapymentioning

confidence: 99%

“…Randomized trials in the era before non-invasive ventilation was used widely showed that multiple doses reduced the risk of air leaks [64] but this may not be true in the era of early CPAP. Using a larger dose of 200 mg/kg poractant alfa for the first dose will reduce the need for redosing [58]. Multiple INSURE has also been successfully employed and does not appear to worsen outcomes [65].…”

Section: Surfactant Therapymentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

et al. 2016

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Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe. Methods for optimal delivery room management have become more evidence based, and protocols for lung protection, including initiation of continuous positive airway pressure and titration of oxygen, should be implemented from soon after birth. Surfactant replacement therapy is a crucial part of the management of RDS, and newer protocols for surfactant administration are aimed at avoiding exposure to mechanical ventilation, and there is more evidence of differences among various surfactants in clinical use. Newer methods of maintaining babies on non-invasive respiratory support have been developed and offer potential for greater comfort and less chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease although minimizing the time spent on mechanical ventilation using caffeine and if necessary postnatal steroids are also important considerations. Protocols for optimizing the general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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“…Post hoc analysis of studies that compared beractant and poractant alfa demonstrated that poractant alfa administered at high doses of 200 mg/kg compared to a lower dose of 100 mg/kg led to increased survival and decreased intraventricular hemorrhage (IVH). Besides, redosing was needed less frequently [11,12,13,14], probably due to the longer half-life of DPPC when administered at the higher 200 mg/kg dose. …”

Section: Surfactant Dosing and Redosingmentioning

confidence: 99%

Surfactant for Respiratory Distress Syndrome: New Ideas on a Familiar Drug with Innovative Applications

Niemarkt¹,

Hütten²,

Kramer³

2017

Neonatology

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In the last 4 decades, advances in neonatology have led to a significant increase in the survival of preterm infants. One of the biggest advances was the introduction of surfactant replacement therapy for the treatment of respiratory distress syndrome. This is the main cause of respiratory insufficiency in preterm infants and is one of the major causes of perinatal morbidity and mortality. Surfactant replacement therapy is already a well-investigated and established therapy in neonatology. However, surfactant replacement therapy has progressed and been refined over recent decades, especially with the increasing care for preterm infants born before 26 weeks' gestational age and the recent clinical focus on avoiding mechanical ventilation. Clinical evidence is evolving on new types of surfactant, surfactant dosages, co-medication given before, with, or after surfactant replacement, and new technical advances regarding the mode of administration.

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Comparison of animal-derived surfactants for the prevention and treatment of respiratory distress syndrome in preterm infants

Cited by 84 publications

References 55 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

Surfactant for Respiratory Distress Syndrome: New Ideas on a Familiar Drug with Innovative Applications

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