Comparison of Two Natural Surfactants for Pulmonary Hemorrhage in Very Low-Birth-Weight Infants: A Randomized Controlled Trial

Bozdağ, Şenol; Díllí, Dílek; Gökmen, Tülin; Dilmen, Uğur

doi:10.1055/s-0034-1389090

Cited by 14 publications

(29 citation statements)

References 20 publications

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“…In another clinical trial by Bozdag et al. they concluded that both Curosurf and Survanta improved oxygenation in VLBW infants with pulmonary hemorrhage but there was no difference for these two drugs for effectiveness on BPD as well as mortality rate [17] . Terek et al., comparing effectiveness of Curosurf and Survanta in preterm infants with RDS, mentioned that improvement of perfusion index (PI) was achieved earlier in Survanta group in comparison with Curosurf group.…”

Section: Discussionmentioning

confidence: 99%

Comparison of efficacy and safety of two available natural surfactants in Iran, Curosurf and Survanta in treatment of neonatal respiratory distress syndrome: A randomized clinical trial

Najafian

Karimi‐Sari

Khosravi

et al. 2016

Contemporary Clinical Trials Communications

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IntroductionThe benefit of surfactant prescription for respiratory distress syndrome (RDS) has been approved. Curosurf and Survanta are two commonly used natural surfactants in Iran. Previous studies did not report priority for one of these two drugs. The present study aimed to compare the effectiveness and safety of Curosurf and Survanta in treatment of RDS.MethodsIn this randomized clinical trial, neonates were born with RDS diagnosis in two governmental and referral hospitals of Tehran (the capital of Iran) in 2014 were randomly selected. Neonates were randomly assigned into two groups receiving 100 mg/kg Curosurf or Survanta as soon as possible after randomization. Complications, mortality and needing the second dose were compared between the two groups.ResultsA total 112 patients with the mean gestational age of 32.59 ± 3.39 weeks were evaluated (56 patients in each group). There were no significant differences regarding birth weight, gestational age, delivery method, and parity between the two groups (P > 0.05). The complications were occurred in 18 neonates (32.1%) of Curosurf group and 20 neonates (35.7%) of Survanta group (RR = 0.922, 95% CI = 0.617–1.379). There were no significant differences regarding complications, mortality, and needing nasal CPAP and endotracheal tube between the two groups. In the neonates with gestational age of 29–32 weeks the IVH and NEC incidence were significantly more in Curosurf group compared to Survanta group (27.8% vs 0% and 22.3% vs 0%, P < 0.05).ConclusionThere was no significant difference in complications or mortality between those two groups; however Curosurf was associated with less need of ET tube (in >32 birth weeks subgroup) and NCPAP (in 29–32 birth weeks subgroup) (p = 0.008). Further evaluations with longer follow-up duration are needed for comparing these two surfactants.

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Section: Discussionmentioning

confidence: 99%

Comparison of efficacy and safety of two available natural surfactants in Iran, Curosurf and Survanta in treatment of neonatal respiratory distress syndrome: A randomized clinical trial

Najafian

Karimi‐Sari

Khosravi

et al. 2016

Contemporary Clinical Trials Communications

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“…There are few clinical trials supporting surfactant use in pneumonia [168], although in a recent observational study babies with RDS complicated by pneumonia seemed to require more surfactant [169]. Surfactant therapy improves oxygenation in babies with pulmonary haemorrhage, and although there are no RCTs looking at outcomes compared with no treatment [170], a recent small trial comparing two different natural surfactant preparations in pulmonary haemorrhage showed more rapid improvement in oxygenation with poractant alfa compared with beractant, but with no differences in other outcomes [171]. There are no data to support routine or rescue use of inhaled nitric oxide (iNO) in preterm babies [172].…”

Section: Managing Blood Pressure and Perfusionmentioning

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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“…Coagulopathy is commonly described in conjunction with PH. 1 Vitamin K was administered in a prospective RCT 8 (n = 42) and a retrospective case series 9 (n = 27) in combination with vasopressors to all neonates studied, although the rationale for this was not described. Neither study evaluated the effectiveness of administration of vitamin K or the vasopressor in inducing cessation of PH or achieving favourable outcomes.…”

Section: Coagulopathymentioning

confidence: 99%

Pulmonary haemorrhage in neonates: Systematic review of management

et al. 2021

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Aim: Pulmonary haemorrhage (PH) is an acute catastrophic event with low incidence yet high mortality among neonates. We aimed to systematically review the management of PH. Methods:A search was carried out of the PubMed, EMBASE and Cochrane databases according to the PRISMA guidelines. Data were extracted on study design and size, patient demographics, primary and adjunctive treatment methods, and treatment outcomes.Results: Sixteen studies with 385 newborn infants were included and were significantly heterogeneous regarding treatment methods. Primary treatments included surfactant, high-frequency oscillatory ventilation (HFOV), epinephrine, coagulopathy management, intermittent positive pressure ventilation, cocaine and tolazoline.Adjunctive treatment methods included blood products, HFOV, increased positive end-expiratory pressure, vitamin K, surfactant, adrenaline, vasopressors and inotropes. All five studies using surfactant as primary treatment were effective in improving oxygenation index measures and preventing recurrence of PH, and three studies found no association between surfactant and death or long-term disability.Ventilatory support, epinephrine, management of coagulopathy and tolazoline were all found to be effective primary treatments for PH. Conclusion:There are several effective methods of managing PH in neonates. Further understanding of the aetiology of PH and ongoing research will allow future prevention and improvements in management of PH.

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Comparison of Two Natural Surfactants for Pulmonary Hemorrhage in Very Low-Birth-Weight Infants: A Randomized Controlled Trial

Abstract: Both natural surfactants improved oxygenation when administered for pulmonary hemorrhage in VLBW infants. The type of surfactant seems to have no effect on BPD and mortality rates in these patients.

Cited by 14 publications

References 20 publications

Comparison of efficacy and safety of two available natural surfactants in Iran, Curosurf and Survanta in treatment of neonatal respiratory distress syndrome: A randomized clinical trial

Comparison of efficacy and safety of two available natural surfactants in Iran, Curosurf and Survanta in treatment of neonatal respiratory distress syndrome: A randomized clinical trial

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

Pulmonary haemorrhage in neonates: Systematic review of management

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