Differences in immediate and short-term outcome of premature neonates treated with two types of exogenous surfactant preparation.

A retrospective review of the use of 2 types of exogenous surfactants was done to detect any differences in the short-term outcome. A total of 77 babies received surfactant replacement during the 1 year and 6 months under review. Of these, 30 had received a modified natural preparation, Survanta, and 47 had received a synthetic preparation, Exosurf. The median age at which the surfactant had been administered was at 4 hours of life. Twenty-three percent of all infants had received antenatal steroids. The infants who had received Survanta showed a more rapid initial response, with a lowering of oxygen requirements 1 hour after administration and improvements in the alveolar-arterial oxygen ratios. At 4 hours after administration, the mean arterial-alveolar oxygen ratio was 0.25 +/- 0.15 in the group given Survanta compared with 0.17 +/- 0.11 in the group treated with Exosurf (P < 0.05). These differences however did not persist beyond the first 12 hours after therapy. There were no significant differences between the 2 groups of infants in terms of survival, development of bronchopulmonary dysplasia, intraventricular haemorrhage or ventilator days. A haemodynamically significant patent ductus arteriosus was clinically evident significantly earlier in babies who had received Survanta (mean age 1.86 days against 2.38 days, P = 0.04). The modified natural surfactants appeared to have a more rapid onset of action. The haemodynamic consequences of this more rapid onset of action have to be anticipated in such infants.