Comparison of Curosurf(R) versus Surfacten(R) in the Treatment of Respiratory Distress Syndrome

PURPOSE: The goal of this study was to compare the effects of treatment of newborn babies with two different surfactants, Curosurf(R) and Surfacten(R). METHODS: We retrospectively reviewed the medical records from 2007 to 2009 and divided the patients into two groups: those who received Curosurf(R) (n=20) and those who received Surfacten(R) (n=21). We compared the groups for sex, gestational age (GA), birth weight, type of delivery, apgar score, maternal history, age at treatment, bronchopulmonary dysplasia (BPD), administration indomethacin for patent ductus arteriosus(PDA), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), periventricular leucomalacia (PVL), retinopathy of prematurity (ROP), pulmonary hemorrhage (PH), pneumothorax (PTX), duration of ventilation, need for oxygen, and administration. RESULTS: The demographic and clinical variables were similar in both groups. The gestational age for Curosurf(R) and Surfacten(R) were 32.7+/-3.1 and, 30.5+/-4.3 weeks, respectively (P=0.08). Six newborns in the Curosurf(R) group and 8 in the Surfacten(R) group developed BPD (P=0.59). No significant differences were noted for NEC, IVH, PVL, ROP, PH, PTX between the two groups (IVH, P=0.14; PVL, P=0.94; ROP P=0.94; PTX P=0.34). The mean duration of ventilation was 16.8 days with Curosurf(R) and 23.7 days with Surfacten(R), but these differences were not statistically significant (P=0.43). The differences in duration of need for oxygen and administration were also not statistically significant (P=0.92, 0.91, respectively). CONCLUSION: This study indicated no significant differences between Curosurf(R) and Surfacten(R). However, because of its convenience and the merit of minimal touching of the babies, the use of Curosurf(R) is recommended.

Comparison of Clinical Efficacy of Newfactan(R) versus Surfacten(R) for the Treatment of Respiratory Distress Syndrome in the Newborn Infants

Newfactan(R) is a domestically developed, bovine lung-derived, semi-synthetic surfactant. The aim of this study was to compare the clinical efficacy of Newfactan(R) with that of Surfacten(R) in the treatment of respiratory distress syndrome (RDS). Newfactan(R) or Surfacten(R) was randomly allocated to 492 newborn infants who were diagnosed as RDS and required surfactant instillation in four participating hospitals. The comparisons were made individually in two subsets of infants by birth weight (or=1,500 g group [n=239]). Short-term responses to surfactant and acute complications, such as the total doses of surfactant instilled, response type, extubation rate, ventilator settings, changes in respiratory parameters, air leak, patent ductus arteriosus, pulmonary hemorrhage, and intraventricular hemorrhage, and mortality during the 96 hr after surfactant instillation were measured. Long-term outcome and complications, such as total duration of intubation, bronchopulmonary dysplasia and periventricular leukomalacia, and ultimate mortality were measured. There were no significant differences in demographic and perinatal variables, shortterm responses to surfactant and acute complications, and long-term outcome and complications between Newfactan(R) and Surfacten(R) in both birth weight groups. We concluded that Newfactan(R) was comparable to Surfacten(R) in the clinical efficacy in the treatment of RDS in both birth weight groups.

Comparison of Surfacten Versus Newfacten for the Treatment of Respiratory Distress Syndrome

PURPOSE: This study was undertaken to determine the comparative efficacy between Surfacten and Newfacten in the early course of respiratory distress syndrome, ventilatory parameters, mortality and complications of RDS. METHODS: For the period of March 1998 to August 1999, total 60 neonates with RDS were treated with Surfacten (n=30) or Newfacten (n=30) at 2 different hospitals. Patients were enrolled for the trial if the following criteria were met; (1) age less than 24 hours; (2) birth weight between 800 gm and 2,500 gm; (3) clinical and radiographic findings consistent with RDS; (4) respiratory distress severe enough to require endotracheal intubation and mechanical ventilation; (5) a written informed consent by a parent. Infants were not eligible if they had a congenital anomaly or proven chromosomal anomaly. Two groups were treated with the equal doses of Surfacten and Newfacten via identical method and the various ventilator parameters, mortality and complications of RDS were compared. RESULTS: Surfacten was administered at 5.8 5.5 hour after birth and Newfacten was administered at 5.9 5.4 hour after birth. There were no differences in birth weight, gestational age in between 2 study groups. Ventilator parameters such as FiO2, MAP, VI, a/APO2 were measured in both groups and the differences were not statistically significant. There were no differences in the incidence of BPD, PDA, IVH, NEC, pneumothorax, pulmonary hemorrhage and ROP between two groups. There were no differences in mortality, the duration of ventilator care, and oxygen therapy between two groups. CONCLUSION: The effectiveness of Newfacten was comparable to that of Surfacten in terms of its efficacy in the treatment of RDS, complications, and mortality.

Effects of Two Different Surfactants on RBC Membrane and Type II Alveolar Epithelial Cell in Vitro

PURPOSE: Respiratory distress syndrome(RDS) is a major cause of death in premature babies. For the treatment of RDS, various artificial pulmonary surfactants have been used. The incidence of pulmonary hemorrhage is increased in association with surfactant therapy in extremely low birth weight infants. But the pathogenesis of this increased incidence is not clear. So we conducted this study to prove whether exposure of RBC or type II alveolar epithelial cell membrane to Surfacten(R) or Exosurf(R) or additive component of Exosurf(R) may lead to increased membrane permeability. METHODS: Washed packed RBC(30microliter) with various concentrations of Surfacten(R), Exosurf(R), hexadecanol and tyroxapol(concentration similar to their content in each Exosurf(R)), were incubated for 2, 24 and 48 hour at 37degrees C. Hemolysis was measured by spectrophotometry. Type II alveolar epithelial cell(HTB-181)(106cell/mL) with 2, 4, 6 and 8mg of Surfacten(R) or Exosurf(R) were incubated for 24 hour at 37degrees C. Lactate dehydrogenase(LDH) release was measured as an indicator of cytotoxicity. RESULTS: RBC hemolysis was increased in a time and dose-dependent manner with both artificial surfactants and additive components of Exosurf(R). This trend, especially, was typically seen in the sample which was incubated for 24 hours, where more hemolysis was seen with Exosurf(R) and tyroxapol than Surfacten(R) and hexadecanol with the above concentration of 2.5mg/2mL(P<0.05). LDH released from type II alveolar epithelial cell with Exosurf(R) was greater than with Surfacten(R), especially at the concentration of 6mg/106cell(P<0.05). CONCLUSION: Artificial surfactant may be associated with in vitro cytotoxicity on RBC membrane and aveolar epithelial cell, and this property was more prominent with Exosurf(R) and the additive components of Exosurf(R), especially with tyroxapol.

Effects of Two Different Surfactants on RBC Membrane and Type II Alveolar Epithelial Cell in Vitro

PURPOSE: Respiratory distress syndrome(RDS) is a major cause of death in premature babies. For the treatment of RDS, various artificial pulmonary surfactants have been used. The incidence of pulmonary hemorrhage is increased in association with surfactant therapy in extremely low birth weight infants. But the pathogenesis of this increased incidence is not clear. So we conducted this study to prove whether exposure of RBC or type II alveolar epithelial cell membrane to Surfacten(R) or Exosurf(R) or additive component of Exosurf(R) may lead to increased membrane permeability. METHODS: Washed packed RBC(30microliter) with various concentrations of Surfacten(R), Exosurf(R), hexadecanol and tyroxapol(concentration similar to their content in each Exosurf(R)), were incubated for 2, 24 and 48 hour at 37degrees C. Hemolysis was measured by spectrophotometry. Type II alveolar epithelial cell(HTB-181)(106cell/mL) with 2, 4, 6 and 8mg of Surfacten(R) or Exosurf(R) were incubated for 24 hour at 37degrees C. Lactate dehydrogenase(LDH) release was measured as an indicator of cytotoxicity. RESULTS: RBC hemolysis was increased in a time and dose-dependent manner with both artificial surfactants and additive components of Exosurf(R). This trend, especially, was typically seen in the sample which was incubated for 24 hours, where more hemolysis was seen with Exosurf(R) and tyroxapol than Surfacten(R) and hexadecanol with the above concentration of 2.5mg/2mL(P<0.05). LDH released from type II alveolar epithelial cell with Exosurf(R) was greater than with Surfacten(R), especially at the concentration of 6mg/106cell(P<0.05). CONCLUSION: Artificial surfactant may be associated with in vitro cytotoxicity on RBC membrane and aveolar epithelial cell, and this property was more prominent with Exosurf(R) and the additive components of Exosurf(R), especially with tyroxapol.

Comparison of in vitro Surface Physical Properties of Four Artificial Exogenous Pulmonary Surfactant Preparations

PURPOSE: We conducted this study to compare the surface physical properties of four commercial preparations of artificial exogenous pulmonary surfactants in vitro which have been used in both the prevention and treatment of respiratory distress syndrome in newborn infants. METHODS: We tested four surfactants : a) Surfacten (Tokyo Tanabe, Japan) and Newfactan (Yuhan, Korea) : reconstituted bovine lung extract, b) Curosurf (Cheisi, Italy) : porcine lung mince; chloroform-methanol extract; liquid-gel chromatography, and c) Exosurf (Wellcome, USA), synthetic surfactant composed of colfosceril, palmitate, hexadecanol, and tyloxapol. We measured the surface adsorption rate, spreading rate, and surface tension(ST)-area diagram by using modified Wilhelmy balance and minimum(min-ST) and maximum ST(max-ST) by Pulsating Bubble Surfactometer. RESULTS: The adsorption rate of Surfacten is less than 30mN/m and those of Newfactan, Curosurf, and Exosurf are more than 30mN/m. The spreading rate of Surfaten and Newfactan are less than 30mN/m, and those of Curosurf and Exosurf are more than 30mN/m. The min-ST of Surfacten and Newfacten are less than 10mN/m, and those of Curosurf and Exosurf are more than 10mN/m. According to high performance of surface physical activities, which are compared with in vitro criteria of effective artificial surfactant, they are as follows; Surfacten>Newfactan>Curosurf>Exosurf. CONCLUSION: There are some differences between the surface physical properties of the four surfactant preparations. The natural surfactants appear to be superior to synthetic surfactant in vitro. Among the natural surfactants, Surfacten showed the best surface physical activities of spreading, adsorption and ST-lowering properties.

A Study of Relation between Stable Microbubble Rating and Surfactant Derivatives (Surfacten : Phospholipid :, Exosurf :Dipalmitoyl-Phosphatidyl Choline) Concentration in Vitro

PURPOSE: With the recent advent of surfactant replacement therapy, there is an increasing need for a rapid and reliable test to predict respiratory distress syndrome (RDS) immediately before or at birth. There are many investigations and methods for the detection of RDS in prenatal or postnatal period. The stable microbubble rating test (SMR-test) developed by pattle et al. is rapid and simple test performed on amniotic fluid and gastric aspirates which reflects the adequacy of pulmonary surfactant with higher diagnostic accuracy. To determine the relation of the SMR and surfactant derivatives [Surfacten : phospholipid (PL), Exosurf : dipalmitoyl-phosphatidyl choline (DPPC) concentration in vitro, author performed SMR test according to 15 groups of surfactant derivatives concentration by using modified Pattle's method. METHODS: Surfacten & Exosurf were diluted each concentration (0, 5, 10, 15, 20, 25, 30, 35, 40, 50, 60, 70, 80, 90, 100microgram/ml) by dilutional fluid. We enveloped test tube by paraffin paper for protection of evaporation. When we performed SMR test, we shaked test tube vigorously by Vlotex shaker. We performed SMR test according to 15 groups of Surfactant concentration by using modified Pattle's method. RESULTS: 1) The number of SMR according to 15 groups of surfactant derivatives concentration were 2, 1/mm2 in 4.2microgram/ml of PL and 3.1microgram/ml of DPPC, 279, 1104/mm2 in 83.3microgram/ml of PL and 61.8microgram/ml DPPC. 2) The regression curve of SMR and surfactant derivatives concentration showed statistically significant relation (p<0.005). CONCLUSION: The SMR test was a good method in estimation of surfactant concentration in vitro and also in diagnosis of RDS recognized as a surfactant deficiency.

Effects of High Frequency Ventilation after Surfactant Replacement Therapy Compared with Conventional Ventilation in the Neonatal Respiratory Distress Syndrome

PURPOSE: We performed a retrospective study to compare effects of Surfacten(R) with HFV administration and meticulous conventional ventilatory support for neonatal RDS by analyzing clinical effects, complication and mortality between two groups. METHODS: Of 107 cases admitted to the nursery in Taegu Fatima hospital from February 1990 to June 1996, 52 neonates (admitted from January 1993 till June 1996) with RDS on high frequency ventilation after Surfacten(R) replacement were included as study group while 57 neonates(admitted from January 1990 till December 1996) with RDS on only conventional ventilation as control group. Serial change of FiO2, MAP, PaO2 and PaCO2 within 48hours after Surfacten(R) replacement, chest X-ray, clinical course, complication and mortality rate were propectively analyzed between two groups. RESULT: 1) After 24 hours Surfacten(R) replacement FiO2 had gradually decreased to 40% in the treated group, while in the control group, decreased to 50% within 48 hours. 2) MAP was maintained at 5.2cmH2O in the treated group, while in the control group, at 6.9cmH2O. 3) Serial change of PaO2 during weaning period after Surfacten(R) replacement between two groups were not significantly different(in the treated group : 74.5mmHg, in the conrol group : 76.1mmHg). 4) Serial change of PaCO2 during weaning period after Surfacten(R) replacement in the treated group were maintained significantly below the level of PaCO2 in the control group(in the treated group : 42.3mmHg, in the control group : 46.6mmHg). 5) In the treated group, complications were a series of PDA, IVH and pneumothorax, while in the control group, of PDA, Sepsis and IVH, and there were no differences between two groups with respect to mortality. CONCLUSION: It was concluded that the combined treatment with Surfacten(R) replacement and high frequency ventilation for neonatal RDS improved short term clinical effects than in the control group, but there were no significant difference in terms of complications and mortality rate between two groups