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

Bovine 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. We performed a comprehensive review of biochemical and pharmacological features of surfac...

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Bibliographic Details
Published in:Respiratory research 2019-02, Vol.20 (1), p.28-13, Article 28
Main Authors: Tridente, Ascanio, De Martino, Lucia, De Luca, Daniele
Format: Article
Language:English
Subjects:
Age
Animals
Care and treatment
Cattle
Clinical trials
Comparative analysis
Dosage and administration
Gestational age
Hemorrhage
Humans
Infant, Newborn
Infant, Premature
Intensive care
Life Sciences
Literature reviews
Lungs
Meetings
Meta-analysis
Methods
Mortality
Neonate
Neonates
Newborn babies
Patient outcomes
Pediatric research
Pharmacology
Pragmatic Clinical Trials as Topic
Proteins
Pulmonary Surfactants - chemistry
Pulmonary Surfactants - therapeutic use
RDS
Respiratory distress syndrome
Respiratory Distress Syndrome, Newborn - drug therapy
Respiratory therapy
Review
Reviews
Surfactant
Surfactants
Swine
Synthetic lung surfactants
Systematic review
Therapy
Ventilators
Web portals
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Description
Summary:Bovine 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. We 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 Search for randomised controlled trials with no language/year restrictions and excluding "grey" literature, unpublished or non-peer reviewed reports was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the most recent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. Sixteen 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 
ISSN:1465-993X
1465-9921
1465-993X
1465-9921
DOI:10.1186/s12931-019-0979-0