Comparison of three natural surfactants according to lung ultrasonography scores in newborns with respiratory distress syndrome

Introduction: Lung ultrasonography (LUS) is a noninvasive bed-side test and increasingly used by clinicians in the management and follow-up of respiratory distress syndrome (RDS) in premature infants.

Objective: To compare the results of three natural surfactants according to LUS scores in premature infants with RDS.

Methods: This was a prospective study on 62 preterm infants (25-34 weeks) with RDS and receiving surfactant according to 2016 European guidelines. All patients underwent a clinical evaluation and chest X-ray at three study points; at the first hours of life (presurfactant), and at 6-12th hour (early postsurfactant) and 24th hour (late postsurfactant) of surfactant. Simultaneously fractional inspired oxygen (FiO₂) need, arterial PaO₂ values, Downes and LUS scores were noted. The patients were randomized into three groups; Group 1 (n = 23), poractant alpha; Group 2 (n = 20), beractant; and Group 3 (n = 19), calfactant. The groups were compared according to clinical, laboratory and radiological variables as well as LUS scores.

Results: Gestational age (p = .05), birthweight (p = .07), and SNAPPE-II scores (p = .57) were similar in three groups. Repeated dose need was the highest in Group 3 (p = .04). FiO₂ need (p = .04) was the highest and PaO₂ values (p = .03) were the lowest at late postsurfactant point in the same group. LUS scores were also the highest in Group 3 at this period (p = .02). Downes scores were similar in groups at all points (p > .05). NICU stay were similar in groups (p = .53). The durations of total oxygen supplementation, mechanical ventilation, and hospital stay were the same in groups (p > .05).

Conclusions: In newborns with RDS, poractant alpha and beractant have similarly reduced oxygen need in accordance to the LUS findings. However, they seem to be superior compared to calfactant.