Download PDF
Am J Perinatol 2015; 32(03): 211-218
DOI: 10.1055/s-0034-1389090
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparison of Two Natural Surfactants for Pulmonary Hemorrhage in Very Low-Birth-Weight Infants: A Randomized Controlled Trial

Şenol Bozdağ
1   Department of Neonatology, Umraniye Research and Training Hospital, İstanbul, Turkey
,
Dilek Dilli
2   Department of Neonatology, Dr Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
,
Tülin Gökmen
3   Department of Neonatology, Bağcılar Research and Training Hospital, İstanbul, Turkey
,
Uğur Dilmen
4   Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
5   Department of Pediatrics and Neonatology, Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
› Author Affiliations
Further Information

Publication History

27 June 2013

19 July 2013

Publication Date:
21 September 2014 (online)

Also available at
    Permissions and Reprints

Abstract

Objective To compare the efficacy of two natural surfactants for pulmonary hemorrhage in very low-birth-weight (VLBW) infants.

Study Design A prospective randomized controlled trial was conducted on 42 infants who were divided into two groups, poractant alfa (n = 21) and beractant (n = 21).

Results In both the groups, the mean standard deviation (SD) birth-weight and gestational age were similar (p = 0.33 and 0.89, respectively). Although, the mean oxygenation index (OI) increased after pulmonary hemorrhage compared with baseline value and decreased after surfactant in both groups, variations in OI were more prominent in poractant alfa group (before hemorrhage: 11.9, after hemorrhage: 22.7, 1 hour of surfactant: 14.6, 8th hour of surfactant: 7.8, 24th hour of surfactant: 8.5, p = 0.007 vs. before pulmonary hemorrhage:11.1, after pulmonary hemorrhage: 17.9, 1 hour of surfactant: 12.8, 8th hour of surfactant: 12.8, 24th hour of surfactant: 9.7, p = 0.02). There was no significant difference between the groups for OI values at all time points (p > 0.05). The rates of bronchopulmonary dysplasia (BPD) and mortality related to pulmonary hemorrhage were similar in both the groups.

Conclusion Both natural surfactants improved oxygenation when administered for pulmonary hemorrhage in VLBW infants. The type of surfactant seems to have no effect on BPD and mortality rates in these patients.

Keywords

premature - pulmonary hemorrhage - surfactant

Author's Contribution

Şenol Bozdağ: Conception and design, acquisition of data, or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be published.


Dilek Dilli: Conception and design, acquisition of data, or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be published.


Tülin Gökmen: Conception and design, acquisition of data, or analysis and interpretation of data.


Uğur Dilmen: Conception and design, acquisition of data, or analysis and interpretation of data, final approval of the version to be published, Clinical Trials registry: “Comparison of Two Different Natural Surfactants in the Treatment of Pulmonary Hemorrhage” www.clinicaltrials.gov NCT01860014.


 

  • References

  • 1 Raju TNK, Langenberg P. Pulmonary hemorrhage and exogenous surfactant therapy: a metaanalysis. J Pediatr 1993; 123 (4) 603-610
    CrossrefPubMedGoogle Scholar
  • 2 Pandit PB, Dunn MS, Colucci EA. Surfactant therapy in neonates with respiratory deterioration due to pulmonary hemorrhage. Pediatrics 1995; 95 (1) 32-36
    PubMedGoogle Scholar
  • 3 Trompeter R, Yu VYH, Aynsley-Green A, Roberton NRC. Massive pulmonary haemorrhage in the newborn infant. Arch Dis Child 1975; 50 (2) 123-127
    CrossrefPubMedGoogle Scholar
  • 4 Horbar JD, Wright LL, Soll RF , et al; National Institute of Child Health and Human Development Neonatal Research Network. A multicenter randomized trial comparing two surfactants for the treatment of neonatal respiratory distress syndrome. J Pediatr 1993; 123 (5) 757-766
    CrossrefPubMedGoogle Scholar
  • 5 Holm BA, Notter RH. Effects of hemoglobin and cell membrane lipids on pulmonary surfactant activity. J Appl Physiol 1987; 63 (4) 1434-1442
    PubMedGoogle Scholar
  • 6 Jobe AH. Pulmonary surfactant therapy. N Engl J Med 1993; 328 (12) 861-868
    CrossrefPubMedGoogle Scholar
  • 7 Speer CP, Robertson B, Curstedt T , et al. Randomized European multicenter trial of surfactant replacement therapy for severe neonatal respiratory distress syndrome: single versus multiple doses of Curosurf. Pediatrics 1992; 89 (1) 13-20
    PubMedGoogle Scholar
  • 8 Ramanathan R. Choosing a right surfactant for respiratory distress syndrome treatment. Neonatology 2009; 95 (1) 1-5
    CrossrefPubMedGoogle Scholar
  • 9 Tomaszewska M, Stork E, Minich NM, Friedman H, Berlin S, Hack M. Pulmonary hemorrhage: clinical course and outcomes among very low-birth-weight infants. Arch Pediatr Adolesc Med 1999; 153 (7) 715-721
    CrossrefPubMedGoogle Scholar
  • 10 Amizuka T, Shimizu H, Niida Y, Ogawa Y. Surfactant therapy in neonates with respiratory failure due to haemorrhagic pulmonary oedema. Eur J Pediatr 2003; 162 (10) 697-702
    CrossrefPubMedGoogle Scholar
  • 11 Pandit PB, O'Brien K, Asztalos E, Colucci E, Dunn MS. Outcome following pulmonary haemorrhage in very low birthweight neonates treated with surfactant. Arch Dis Child Fetal Neonatal Ed 1999; 81 (1) F40-F44
    CrossrefPubMedGoogle Scholar
  • 12 Ortiz RM, Cilley RE, Bartlett RH. Extracorporeal membrane oxygenation in pediatric respiratory failure. Pediatr Clin North Am 1987; 34 (1) 39-46
    PubMedGoogle Scholar
  • 13 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (4) 529-534
    CrossrefPubMedGoogle Scholar
  • 14 Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986; 33 (1) 179-201
    PubMedGoogle Scholar
  • 15 Northway Jr WH. Observations on bronchopulmonary dysplasia. J Pediatr 1979; 95 (5 Pt 2) 815-818
    CrossrefPubMedGoogle Scholar
  • 16 An international classification of retinopathy of prematurity. The Committee for the Classification of Retinopathy of Prematurity. [No authors listed]. Arch Ophthalmol. 1984; 102 (8) 1130-1134
    PubMedGoogle Scholar
  • 17 Alfaleh K, Smyth JA, Roberts RS, Solimano A, Asztalos EV, Schmidt B ; Trial of Indomethacin Prophylaxis in Preterms Investigators. Prevention and 18-month outcomes of serious pulmonary hemorrhage in extremely low birth weight infants: results from the trial of indomethacin prophylaxis in preterms. Pediatrics 2008; 121 (2) e233-e238
    CrossrefPubMedGoogle Scholar
  • 18 Strauss T, Rozenzweig N, Rosenberg N , et al. Surfactant impairs coagulation in-vitro: a risk factor for pulmonary hemorrhage?. Thromb Res 2013; 132 (5) 599-603
    CrossrefPubMedGoogle Scholar
  • 19 Rogers D. Pulmonary haemorrhage, surfactant, and low-birthweight babies. Lancet 1993; 341 (8846) 698
    PubMedGoogle Scholar
  • 20 Li L, Yu J, Wang J , et al. A prediction score model for risk factors of mortality in neonate with pulmonary hemorrhage: the experience of single neonatal intensive care unit in Southwest China. Pediatr Pulmonol 2008; 43 (10) 997-1003
    CrossrefPubMedGoogle Scholar
  • 21 Lin TW, Su BH, Lin HC , et al. Risk factors of pulmonary hemorrhage in very-low-birth-weight infants: a two-year retrospective study. Acta Paediatr Taiwan 2000; 41 (5) 255-258
    PubMedGoogle Scholar