Have we been down this road before?

Lutchman, Dhamend

doi:10.1038/jp.2010.88

Cited by 5 publications

(4 citation statements)

References 4 publications

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“…However, it is unclear how surfactants could influence several non-pulmonary life-threatening complications (i.e. : intracranial haemorrhage, necrotizing enterocolitis, late-onset sepsis) in this highly vulnerable population [45, 51].…”

Section: Discussionmentioning

confidence: 99%

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Porcine vs bovine surfactant therapy for preterm neonates with RDS: systematic review with biological plausibility and pragmatic meta-analysis of respiratory outcomes

2019

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BackgroundBovine surfactants are known to be clinically equivalent but it is unclear if porcine or bovine surfactants at their licensed dose should be preferred to treat respiratory distress syndrome in preterm neonates.MethodsWe performed a comprehensive review of biochemical and pharmacological features of surfactants to understand the biological plausibility of any clinical effect. We then performed a pragmatic meta-analysis comparing internationally marketed porcine and bovine surfactants for mortality and respiratory outcomes. Search for randomised controlled trials with no language/year restrictions and excluding “grey” literature, unpublished or non-peer reviewed reports was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the most recent methodological recommendations.ResultsSixteen articles were included in the review and 14 in the meta-analysis (1491 neonates). 200 mg/kg poractant-α (a porcine surfactant) was associated with lower BPD/mortality (OR 0.632[95%CI:0.494, 0.809];p < 0.001),BPD (OR 0.688[95%CI:0.512, 0.925];p = 0.013), retreatment (OR 0.313[95%CI:0.187, 0.522];p < 0.0001), airleaks (OR 0.505[95%CI:0.308, 0.827];p = 0.006) and lung haemorrhage (OR 0.624[95%CI:0.388, 1];p = 0.051). Gestational age is associated with effect size for BPD (coefficient: 0.308 [95%CI:0.063, 0.554];p = 0.014) and surfactant retreatment (coefficient: -0.311 [95%CI:-0.595, − 0.028];p = 0.031).Conclusion200 mg/kg poractant-α is associated with better respiratory outcomes compared to bovine surfactants at their licensed dose. The effect of poractant-α on BPD and surfactant retreatment is greater at lowest and highest gestational ages, respectively.Trial registrationPROSPERO n.42017075251.Electronic supplementary materialThe online version of this article (10.1186/s12931-019-0979-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

“…We did not perform analyses about any extra-pulmonary outcome, as this is the subject of another presently ongoing project. Moreover, it is a matter of debate how surfactant may influence these outcomes, especially in an era of antenatal steroids use and less invasive ventilation policies [45, 51].…”

Section: Discussionmentioning

confidence: 99%

Porcine vs bovine surfactant therapy for preterm neonates with RDS: systematic review with biological plausibility and pragmatic meta-analysis of respiratory outcomes

2019

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“…Finally, as further additional analysis, we aimed to understand why, from a physiopathological standpoint, surfactant replacement therapy (with any surfactant) would be able to improve extra-pulmonary outcomes, as this is actually debated [14,15]. Thus, we performed a comprehensive review of possible physiopathological and biological mechanisms by which surfactant could influence extra-pulmonary outcomes.…”

Section: Additional Analysesmentioning

confidence: 99%

“…However, it is not clear if surfactant can actually have any effect on extra-pulmonary outcomes [14,15]. Trials published so far have reported the more common complications of prematurity as secondary outcomes and, subsequently, these have been taken into account by meta-analyses.…”

Section: Introductionmentioning

confidence: 99%

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

Foligno

Luca

2020

Respir Res

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Background: While porcine seems to be superior to bovine surfactants in terms of respiratory outcomes, it is unclear if a surfactant can improve extra-pulmonary outcomes in preterm neonates with respiratory distress syndrome and if there is any physiopathological/biological mechanism linking surfactant therapy to these outcomes. We aim to fill these knowledge gaps. Methods: Systematic and pragmatic review coupled with meta-analysis of randomized controlled trials of bovine or porcine surfactants administered to treat RDS in preterm neonates; common extra-pulmonary neonatal intensive care outcomes were considered. As additional analysis, animal or human translational studies about mechanisms linking surfactant replacement to extra-pulmonary neonatal outcomes were also systematically reviewed. Results: Porcine surfactant is associated with lower incidence of patent ductus arteriosus (OR:0.655; 95%CI:0.460-0.931); p = 0.018; 12 trials; 1472 patients); prenatal steroids (coeff.:-0.009, 95%CI:-0.03-0.009, p = 0.323) and gestational age (coeff.:0.079, 95%CI:-0.18-0.34, p = 0.554) did not influence this effect size. No significant differences were found between porcine and bovine surfactants on neonatal intensive care unit length of stay (mean difference (days):-2.977; 95%CI:-6.659-0.705; p = 0.113; 8 trials; 855 patients), intra-ventricular hemorrhage of any grade (OR:0.860; 95%CI:0.648-1.139); p = 0.293; 15 trials; 1703 patients), severe intra-ventricular hemorrhage (OR:0.852; 95%CI:0.624-1.163); p = 0.313; 15 trials; 1672 patients), necrotizing entero-colitis (OR:1.190; 95%CI:0.785-1.803); p = 0.412; 9 trials; 1097 patients) and retinopathy of prematurity (OR:0.801; 95%CI:0.480-1.337); p = 0.396; 10 trials; 962 patients). Conclusions: Physiopathological mechanisms explaining the effect of surfactant have been found for patent ductus arteriosus only, while they are lacking for all other endpoints. Porcine surfactant is associated with lower incidence of PDA than bovine surfactants. As there are no differences in terms of other extra-pulmonary outcomes and no physiopathological plausibility, these endpoints should not be used in future trials. Registration: PROSPERO n.CRD42018100906.

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Do we walk the well‐trodden road (again)?

Lutchman¹

2020

Pediatric Pulmonology

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Have we been down this road before?

Cited by 5 publications

References 4 publications

Porcine vs bovine surfactant therapy for preterm neonates with RDS: systematic review with biological plausibility and pragmatic meta-analysis of respiratory outcomes

Porcine vs bovine surfactant therapy for preterm neonates with RDS: systematic review with biological plausibility and pragmatic meta-analysis of respiratory outcomes

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

Do we walk the well‐trodden road (again)?

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