Efficacy of Porcine Versus Bovine Surfactants for Preterm Newborns With Respiratory Distress Syndrome: Systematic Review and Meta-analysis

Abstract

OBJECTIVE:To compare the efficacy of a porcine surfactant (poractant alfa) versus bovine surfactants (beractant and calfactant) with respect to clinical outcomes among preterm infants with respiratory distress syndrome.METHODS:A search of major electronic databases, including Medline (1980–2010) and the Cochrane Central Register of Controlled Trials, for randomized controlled trials that compared poractant alfa versus beractant and/or calfactant among preterm infants with respiratory distress syndrome who required intubation and surfactant treatment was performed. The primary outcome was oxygen requirement at a postmenstrual age of 36 weeks.RESULTS:Five randomized controlled trials involving 529 infants compared poractant alfa versus beractant for rescue treatment. No trials studied surfactant prophylaxis, and none compared poractant alfa versus calfactant. The incidences of oxygen dependence at a postmenstrual age of 36 weeks were similar for poractant alfa and beractant. Infants treated with poractant alfa at 100 mg/kg (low dose) or 200 mg/kg (high dose) exhibited statistically significant reductions in deaths (relative risk: 0.51 [95% confidence interval: 0.30–0.89]), the need for redosing (relative risk: 0.71 [95% confidence interval: 0.57–0.88]), oxygen requirements, duration of oxygen treatment, and duration of mechanical ventilation. The test of heterogeneity yielded positive results for the latter 2 outcomes. The difference remained statistically significant for deaths and the need for redosing with high-dose poractant alfa but not for low dose poractant alfa.CONCLUSIONS:There were significant reductions in deaths and the need for redosing with high-dose poractant alfa but not low-dose poractant alfa, compared with beractant.