In this review, the authors assess major outcomes resulting from head-to-head comparison trials of animal-derived
surfactants with previous and newer synthetic
surfactants and among them. They also pay special attention to issues of study design and quality of the trials reviewed. Animal-derived
surfactants that contain
surfactant proteins (
Survanta,
Infasurf, and
Curosurf) perform clinically better than
Exosurf, a synthetic
surfactant containing only
phospholipids, primarily in outcomes related to acute management of
respiratory distress syndrome (RDS; faster weaning and
pneumothorax) but not in overall mortality or incidence of
bronchopulmonary dysplasia (BPD). Trials comparing various animal-derived
surfactants that provide different amounts of
surface protein B (SP-B) or
phospholipids have shown minor differences in outcomes related to the management of RDS or none at all. The exception is the suggestion of better survival using a high initial dose of
Curosurf when compared with
Survanta. This observation is based on analysis of trials of relatively lesser quality that have included a smaller number of infants than other
surfactant comparisons, however. Data from recent trials comparing a new-generation synthetic
surfactant that contains a
peptide mimicking the action of SP-B, Surfaxin, have shown that it performs better than
Exosurf (faster weaning and less BPD) and at least as well as the animal-derived
surfactants Survanta and
Curosurf. The ideal
surfactant comparison trial to demonstrate which
surfactant is better has yet to be conducted. Future
surfactant comparison trials should pay particular attention to study design, be appropriately sized, and include long-term follow-up.