Multicenter study of surfactant (beractant) use in the treatment of term infants with severe respiratory failure

Surfactant for Pediatric Acute Lung Injury

“…The randomized controlled study of Findlay et al [133] found reductions in the incidence of pneumothorax, duration of mechanical ventilation and oxygen therapy, time of hospitalization, and requirements for ECMO in 20 term infants treated with Survanta® compared to controls. Lotze et al [130,131] also reported favorable results using Survanta® in a controlled trial in term infants referred for ECMO due to severe respiratory failure (meconium aspiration was a prevalent diagnosis in both studies). Twenty-eight infants treated with four doses of Survanta® (150 mg/kg) had improved pulmonary mechanics, decreased duration of ECMO treatment, and a lower incidence of complications after ECMO compared to control infants [130].…”

“…Twenty-eight infants treated with four doses of Survanta® (150 mg/kg) had improved pulmonary mechanics, decreased duration of ECMO treatment, and a lower incidence of complications after ECMO compared to control infants [130]. A subsequent multicenter controlled trial in 328 term infants also reported significant improvements in respiratory status and the need for ECMO following surfactant treatment [131]. Surfactant therapy has also been found to be beneficial to lung function or respiratory outcome in several studies in infants with viral respiratory (RSV) infection [134,135,139].…”

“…A significant number of clinical studies have reported benefits following the instillation of exogenous surfactants to term infants, children, or adults with ALI/ARDS or related acute respiratory failure [25,[120][121][122][123][124][125][126][127][128][129][130][131][132][133][134][135] (Table 4). However, many of these are small case series or pilot studies, and found only improvements in acute lung function (oxygenation).…”

“…The best-studied application of surfactant therapy in term infants with acute pulmonary injury is in meconium aspiration syndrome [129][130][131][132][133]. Meconium obstructs and injures the lungs when aspirated and is known to cause surfactant dysfunction [56,138].…”

“…SP-B is known to be the most active of the hydrophobic surfactant proteins in enhancing the adsorption, dynamic surface activity, and inhibition resistance of phospholipids [118,[176][177][178][179][180][181][182][183][184]. The addition of bovine SP-B or synthetic SP-B peptides to Survanta® significantly improves its surface and physiological activity towards that of Infasurf and whole surfactant [106,118,175] (Figure 5)‥ Despite its lack of SP-B, other active components such as SP-C in Survanta® allow it to have significant efficacy in some forms of ALI/ARDS as noted earlier (e.g., [130,131,133]). Treatment with Survanta® has not been found to give substantial improvements in adult patients with ARDS [137], but Category I exogenous surfactants with the complete mix of surfactant lipids and near-endogenous amounts of both SP-B and SP-C may prove to have increased efficacy.…”