Effects of Two Different Exogenous Surfactant Preparations on Serial Peripheral Perfusion Index and Tissue Carbon Monoxide Measurements in Preterm Infants with Severe Respiratory Distress Syndrome

Abstract

Patients with RDS had poor perfusion, and PI improved with both surfactant preparations only following a short decline in the 1(st) minute. The expected improvement of PI occurred earlier in the beractant subgroup. TCO declined in both groups, showing lung improvement and decreased oxidative/inflammatory stress, and it was normalized earlier with poractant alfa.

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

“…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. They also reported that inflammatory or oxidative stress was normalized earlier with Curosurf [18] . Eras et al.…”

Porcine versus bovine surfactant therapy for RDS in preterm neonates: pragmatic meta-analysis and review of physiopathological plausibility of the effects on extra-pulmonary outcomes

“…Additionally, we also searched PubMed, using key words and/or MeSH terms as described in the Additional file 1, looking for animal or human translational investigations on these mechanisms. Fig.1 illustrates the project flow-chart: we included 17 studies in the systematic review [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] and we excluded two papers from the meta-analysis, as they investigated two non-internationally marketed porcine surfactants [43,44]. Compared to our previous metaanalysis on respiratory endpoints, there was one more study reporting on the extra-pulmonary outcomes [45].…”

“…These results are only partially similar to those of the earlier Cochrane meta-analysis [8] but they are also stronger. In fact, compared to the previous work we: 1) included five more trials (accounting for ≈600 neonates); 2) used a trials aggregation based on the current best knowledge, that is, on the clinical equivalence of bovine surfactant [8]; 3) analyzed the effect of possible confounders, such as [46][47][48][49] ↓ Prostaglandins synthesis [50,51] ↓ PVR [46,47,[52][53][54] IVH ↓ PaCO2 and CBF [55][56][57] ↓ PDA [53,54] Better peripheral perfusion [34,42] Improved cerebral oxygenation [58] ROP ↓ oxygen and ROS exposure [49,[59][60][61][62][63] NEC ↓ oxygen and ROS exposure [49,64] Better peripheral perfusion [34,42] Earlier progression to full enteral feeding [65][66][67][68] More details in the text. Abbreviations: ROS Reactive oxygen species, PVR Pulmonary vascular resistances, CBF Cerebral blood flow, PaCO2 Arterial partial pressure of CO2, PDA Patent ductus arteriosus, IVH Intraventricular hemorrhage, ROP Retinopathy of prematurity, NEC Necrotizing enterocolitis antenatal steroids or gestational age, and finally, 4) reviewed the possible physiopathological mechanisms linking surfactant replacement and extra-pulmonary outcomes.…”

“…A reduced incidence of hemodynamically significant PDA could also theoretically influence the occurrence of IVH, but there are no convincing data linking PDA to IVH occurrence [77]. The achievement of a better peripheral perfusion in the peri-administration period has also been linked to IVH and NEC reduced incidence, however available data are not consistent and not all variables related to peripheral perfusion coherently change during surfactant dosing [34,42]. A reduction in oxidative damage has been hypothesized as link between surfactant replacement and reduced incidence of ROP and NEC.…”

Extrapulmonary Surfactant Therapy: Review of Available Data and Research/Development Issues

“…However, the reduction in oxygen radicals has also been suggested to mediate an indirect beneficial effect on NEC incidence when surfactant is intratracheally given to treat RDS. 38 The classical intratracheal use of surfactant would also entail better peripheral oxygenation and perfusion 39,40 and a quicker progression to full enteral feeding in preterm babies. 41 However, it is not confirmed if these mechanisms can actually influence NEC pathobiology, and it is difficult to think that a single drug administration performed several weeks prior to NEC occurrence in another organ could interfere with its complex physiopathology.…”