This review examines the 11 randomised clinical trials that have compared different
surfactant preparations. Seven trials, enrolling 2488 infants with
respiratory distress syndrome (RDS), compared the natural
surfactant beractant (
Survanta) with the synthetic
surfactant colfosceril palmitate (
Exosurf Neonatal). Infants treated with
beractant had lower
oxygen requirements for at least 3 days than those treated with
colfosceril palmitate. The infants treated with
beractant also had lower risks of neonatal mortality [odds ratio (OR) 0.81; 95% confidence interval (CI) 0.65 to 1.01],
retinopathy of prematurity (OR 0.81; 95% CI 0.66 to 0.99), and the combined endpoint of death or
bronchopulmonary dysplasia (OR 0.86; 95% CI 0.75 to 0.99), compared with those treated with
colfosceril palmitate. Calf lung
surfactant extract (CLSE;
Infasurf), another natural
surfactant, has been compared with
colfosceril palmitate in 2 studies: in one as prophylaxis and in the other as rescue
therapy. Similar, although nonsignificant, advantages were found for the natural
surfactant compared with the synthetic
surfactant. In 6 of these 9 trials there was a significant reduction in the odds of pulmonary air leaks (OR 0.53; 95% CI 0.41 to 0.64) for infants treated with natural compared with synthetic
surfactants. In 7 trials (3554 infants) comparing natural and synthetic
surfactants to treat RDS (6 comparing
beractant and
colfosceril palmitate, and one CLSE and
colfosceril palmitate), there was a significantly reduced risk of neonatal mortality (OR 0.80; 95% CI 0.66 to 0.97) with natural compared with synthetic
surfactant treatment. In 2 further trials, different natural
surfactant preparations have been compared. Reduced
oxygen needs for 24 hours
after treatment were found for CLSE and
Curosurf (porcine-derived lung
surfactant, PLS) when each was compared with
beractant. Apparent longer term benefits from these
surfactants were not statistically proven. Further trials are needed to be certain of the differences between the various
surfactant preparations.